目的 系统评价胃镜下慢性萎缩性胃炎诊断的临床价值.方法 以我院内镜资料为第一部分,以Meta分析方法全面收集2000年以来我国公开发表的关于胃镜下慢性萎缩性胃炎诊断准确性分析的文献所提供数据为第二部分,全面收集慢性萎缩性胃炎内镜诊断准确性资料,进行Meta分析.结果 Meta分析提示各试验间具有明显的异质性,合并敏感度(SEN)80.3%[95%CI(0.790,0.816)],合并特异度(SPE)94.4%[95%CI(0.938,0.948)],阳性似然比(LR+)7.448[95%CI(2.703,20.522)],阴性似然比(LR-)0.377[95%CI(0.210,0.676)],SROC曲线下面积(AUC)=0.806.结论 由于诊断标准、操作人员技术等方面的原因,Meta分析提示各地文献报道数据具有明显的异质性,胃镜下慢性萎缩性胃炎的诊断具有较低的合并敏感度和较高的合并特异度,通过统一的诊断标准与规范化培训,敏感度与特异度尚有一定的提升空间,就目前而言,对于不适宜或不能接受活检的患者,胃镜下萎缩性胃炎诊断具有较高的临床价值.%Objective To conduct a systematic review of clinical value for endoscopic diagnosis of chronic atrophic gastritis. Methods We selected both of the clinical dates in our hospital and the published dates in Chinese journals from 2000 to 2011, which evaluated the accuracy of endoscopic diagnosis of chronic atrophic gastritis, and then performed systematic review and Meta - analysis. Results Meta analysis revealed a remarkable heterogeneity among all the trials. The pooled sensitivity for endoscopic diagnosis was 80. 3% [ 95% CI ( 0. 790, 0. 816 ) ], and the pooled specificity was 94. 4% [ 95% CI ( 0. 938, 0. 948 ) ]. The positive likelihood ratio ( LR+ ) was 7. 448 [ 95% CI ( 2. 703 , 20. 522 )], and the negative likelihood ratio ( LR- ) was 0. 377 [ 95% CI (0. 210, 0. 676 ) ]. The SROC area under the curve ( AUC ) was 0. 806. Conclusion Because of different diagnostic criteria and operators' skills there is a significant heterogeneity among all the trial. The endoscopic diagnosis of chronic atrophic gastritis has lower pooled sensitivity but higher pooled specificity. There is still a room for improvement of the sensitivity and specificity of endoscopic diagnosis by unifying the diagnostic criterion and standardized training. Nevertheless, for the patients who do not accept or are not suitable for biopsy, the endoscopic diagnosis of chronic atrophic gastritis is of a higher clinical value.
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