[1]王浩军,张从建,李万富,等.肝被膜下血流诊断胆道闭锁系统综述与Meta分析[J].临床小儿外科杂志,2025,(07):635-642.[doi:10.3760/cma.j.cn101785-202503018-007]
　Wang Haojun,Zhang Congjian,Li Wanfu,et al.Importance of hepatic subcapsular flow in the diagnosis of biliary atresia: a systematic review and Meta-analysis[J].Journal of Clinical Pediatric Surgery,2025,(07):635-642.[doi:10.3760/cma.j.cn101785-202503018-007]
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肝被膜下血流诊断胆道闭锁系统综述与Meta分析

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 期数: 2025年07 页码: 635-642 栏目: 论著 出版日期: 2025-07-28
Title:
Importance of hepatic subcapsular flow in the diagnosis of biliary atresia: a systematic review and Meta-analysis
作者:
王浩军1;  张从建2;  李万富1;  艾尼娃·克然木1;  梁鹏1;  王雅琦1;  张滔1;  刘晨萌3
1. 新疆医科大学第一附属医院小儿普外科, 乌鲁木齐 830054;
2. 新疆维吾尔自治区第四人民医院, 乌鲁木齐 830000;
3. 新疆医科大学第一附属医院小儿心胸外科, 乌鲁木齐 830054
Author(s):
Wang Haojun1;  Zhang Congjian2;  Li Wanfu1;  Ainiwaer Keranmu1;  Liang Peng1;  Wang Yaqi1;  Zhang Tao1;  Liu Chenmeng3
1. Department of Pediatric General Surgery, First Affiliated Hospital, Xinjiang Medical University, Urumqi 830054, China;
2. Fourth People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, China;
3. Department of Pediatric Cardiothoracic Surgery, First Affiliated Hospital, Xinjiang Medical University, Xinjiang Medical University, Urumqi 830054, China
关键词:
胆道闭锁; 超声; 肝被膜下血流; 诊断; Meta分析
Keywords:
Biliary Atresia; Ultrasound; Hepatic Subperitoneal Blood Flow; Diagnosis; Meta-Analysis
DOI:
10.3760/cma.j.cn101785-202503018-007
摘要:
目的 胆道闭锁(biliary atresia,BA)是一种累及肝内和肝外胆管的梗阻性胆管疾病,早期诊断对改善患儿的临床预后至关重要。本研究旨在系统评估肝被膜下血流(hepatic subcapsular flow,HSF)在BA诊断中的应用价值。方法 按照循证医学方法,在PubMed、Embase、Web of Science、中国知网和万方数据库中检索自建库之日至2025年2月28日期间发表的HSF诊断BA的相关研究,英文检索词包括:Biliary atresia、Diagnostic Ultrasound、Screening;中文检索词包括:胆道闭锁、超声、诊断。根据纳入与排除标准,由2位研究人员独立对检索后的文献进行筛选并提取指标,包括作者、发表年份、发表国家、设备生产厂家、研究设计类型、总样本量、性别、日龄中位数(或均值)、灵敏度(sensitivity,Se)、特异度(specificity,Sp)、阳性预测值(positive predictive value,PPV)和阴性预测值(negative predictive value,NPV)等,利用Meta-disc 1.4和STATA 18.0对上述指标进行统计分析。通过汇总受试者操作特征曲线(summary receiver operating characteristic curve,SROC curve)和斯皮尔曼相关系数评估阈值效应;根据I2和Q检验结果判断异质性,若I2＞50%则采用随机效应模型并进行Meta回归分析、亚组分析(按日龄≤60天与＞60天分组)及敏感性分析探索异质性;最后使用Deeks’ 检验评估发表偏倚,绘制Fagan列线图及贝叶斯概率修订图,以综合评价HSF对BA的诊断价值。结果 共纳入9项研究(780例患儿),Meta分析结果显示:Se=0.89(95%CI:0.85~0.92),Sp=0.92(95%CI:0.89~0.94),PLR=8.70(95%CI:6.40~11.84),NLR=0.10(95%CI:0.04~0.24),DOR=91.48(95%CI:36.24~230.90),AUC=0.96。在异质性探索中,SROC curve及斯皮尔曼相关系数结果提示无阈值效应。I2=56.2%,采用随机效应模型探索异质性。Meta回归分析以发表年份、研究类型、日龄作为协变量,未发现异质性来源。亚组分析发现,研究的异质性可能来源于亚组日龄≤60天。在敏感性分析中,证明了纳入的研究具有较高稳定性,且无发表偏倚(P=0.23)。结论 HSF作为一种非侵入性诊断手段,具有便捷、准确和可靠的特点,能够显著提高BA的诊断效率。然而,由于在本次Meta分析中不同研究存在较高的异质性,未来需要通过更多的前瞻性、多中心、大样本量的研究进一步验证其诊断准确性。
Abstract:
Objective Biliary atresia (BA) is an obstructive biliary tract disease involving both intrahepatic and extrahepatic bile ducts.An early diagnosis is crucial for improving the clinical outcomes of children.This study was intended to systematically evaluate the application value of hepatic subcapsular flow (HSF) in the diagnosis of BA. Methods In accordance with the methods of evidence-based medicine,a search was conducted in the databases of PubMed,Embase,Web of Science,CNKI (China National Knowledge Infrastructure) and WANFANG for relevant studies of diagnosing BA using HSF published from the establishment of databases up until February 28,2025.The search terms included Chinese and English equivalents such as "biliary atresia","ultrasound" and "diagnosis".According to the inclusion and exclusion criteria,two researchers independently screened the retrieved literature and extracted indicators[author,publication year,publication country,equipment manufacturer,research design type,total sample size,gender,median or mean age in days,sensitivity (Se),specificity (Sp),positive predictive value (PPV),negative predictive value (NPV),etc.].Meta-disc 1.4 and STATA 18.0 were utilized for statistically analyzing the above-mentioned indicators.The threshold effect was evaluated through summary receiver operating characteristic (SROC) curve and Spearman’s correlation coefficient.Heterogeneity was determined by Ih and Q tests.If It >50%,a random-effect model was adopted.Meta-regression,subgroup (grouped by age ≤60 days & >60 days) and sensitivity analyses were carried out for exploring the sources of heterogeneity.Finally Deeks’ test was employed for evaluating publication bias.Fagan’s nomogram and Bayesian probability revision plot were plotted for comprehensively evaluating the diagnostic value of HSF. Results Nine studies involving a total of 780 children were included.There were a sensitivity (Se) of 0.89(95%CI:0.85itivity (Se) of 0.89is showed e2(95%CI:0.89-0.94),positive likelihood ratio (PLR) of 8.70 (95%CI:6.40-11.84),negative likelihood ratio (NLR) of 0.10(95%CI:0.04-0.24),diagnostic odds ratio (DOR) of 91.48(95%CI:36.24-230.90) and area under the curve (AUC) of 0.96.Exploration of heterogeneity via summary receiver operating characteristic (SROC) curve and Spearman’s correlation coefficient hinted at no threshold effect.With an Io value of 56.2%,a random-effects model was employed for statistical analysis of heterogeneity.Meta-regression,using publication year,study type and days of age as covariates,revealed no sources of heterogeneity.Subgroup analysis suggested that inter-study heterogeneity might originate from the subgroup aged ≤ith patient age ht originate from the sua high stability of included studies and an absence of publication bias. Sensitivity analysis confirmed the robustness of included studies and the absence of publication bias (P=0.23). Conclusions As a non-invasive diagnostic modality,HSF is convenient,accurate and reliable.It can significantly improve the diagnostic efficiency of BA.However,due to high heterogeneity in this study,more prospective,multi-center and large-sample studies are required in the future for further verifying its diagnostic accuracy.

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备注/Memo

收稿日期:2025-3-7。
基金项目:新疆维吾尔自治区重点研发任务专项项目资助(2023B03018-2);2023天山英才人才培养计划(TSYC202301A072)
通讯作者:李万富,Email:liwanfu71@163.com

更新日期/Last Update: 2025-07-28