Huynh David, Rubtsov Denis, Basu Debapama, Khaing Myat Myat
The Prince Charles Hospital, Brisbane 4032, Australia.
J Clin Med. 2024 May 21;13(11):3030. doi: 10.3390/jcm13113030.
Inflammatory bowel disease (IBD) consists of Crohn's disease (CD) and Ulcerative colitis (UC). The main goal of treatment is to obtain mucosal healing via endoscopy. More recently, intestinal ultrasounds, along with biochemical markers, have been increasingly popular as point-of-care testing to monitor treatment response. This systemic review and meta-analysis aimed to assess the diagnostic test performance of ultrasonography and biochemical markers (C-reactive protein and fecal calprotectin) compared with endoscopy for detecting inflammation in IBD. : A comprehensive literature search was conducted using PubMed Medline, EMBASE, ScienceDirect, and CINAHL from 1 January 2018 to 1 January 2024. The included studies were prospective and retrospective observational studies, clinical trials, and cross-sectional studies investigating the diagnostic sensitivity and specificity of ultrasonography, biochemical markers, and endoscopy. Studies were selected based on the Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA). Of the 1035 studies retrieved, 16 met the inclusion criteria, and most of the included studies were prospective observational studies. Diagnostic test accuracy was conducted, and the pooled sensitivity and specificity of all the studies revealed that ultrasonography has the highest pooled sensitivity, at 85% (95% CI, 78 to 91%), and specificity, at 92% (95% CI, 86 to 96%), as compared with biochemical markers and endoscopy. More specifically, biochemical markers had a pooled sensitivity and specificity of 85% (95% CI, 81 to 87%) and 61% (95% CI, 58 to 64%), respectively, and endoscopy had 60% (95% CI, 52 to 68%) and 82% (95% CI, 76 to 87%), respectively. However, the results also show substantial heterogeneity in the studies because of various populations, protocols, and outcomes in the studies included. This was especially noted in the assessment of biochemical markers, in which a metaregression was performed showing a nonsignificant -value of 0.8856 for the coefficient. IUS was found to have the highest pooled sensitivity and specificity of all the included studies for diagnosing inflammation in patients with CD and UC, and this, coupled with biochemical markers, can improve diagnostic utility.
炎症性肠病（IBD）包括克罗恩病（CD）和溃疡性结肠炎（UC）。治疗的主要目标是通过内镜检查实现黏膜愈合。最近，肠道超声以及生化标志物作为即时检测手段来监测治疗反应越来越受欢迎。本系统评价和荟萃分析旨在评估超声检查和生化标志物（C反应蛋白和粪便钙卫蛋白）与内镜检查相比在检测IBD炎症方面的诊断测试性能。从2018年1月1日至2024年1月1日，使用PubMed Medline、EMBASE、ScienceDirect和CINAHL进行了全面的文献检索。纳入的研究为前瞻性和回顾性观察性研究、临床试验以及横断面研究，调查超声检查、生化标志物和内镜检查的诊断敏感性和特异性。研究根据系统评价和荟萃分析报告规范（PRISMA）进行选择。在检索到的1035项研究中，16项符合纳入标准，纳入的研究大多为前瞻性观察性研究。进行了诊断测试准确性分析，所有研究的合并敏感性和特异性显示，与生化标志物和内镜检查相比，超声检查的合并敏感性最高，为85%（95%CI，78%至91%），特异性为92%（95%CI，86%至96%）。更具体地说，生化标志物的合并敏感性和特异性分别为85%（95%CI，81%至87%）和61%（95%CI，58%至64%），内镜检查分别为60%（95%CI，52%至68%）和82%（95%CI，76%至87%）。然而，结果还显示，由于纳入研究中的各种人群、方案和结局，研究存在很大异质性。这在生化标志物评估中尤为明显，其中进行的元回归显示系数的P值为0.8856，无统计学意义。在所有纳入研究中，肠道超声被发现对诊断CD和UC患者的炎症具有最高的合并敏感性和特异性，并且与生化标志物相结合，可以提高诊断效用。
