中国循证医学杂志

中国循证医学杂志

肝癌筛查技术准确性的 Meta 分析

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目的 系统评价不同肝癌筛查技术的准确性,为人群筛查和早期诊断提供依据。 方法 计算机检索 PubMed、The Cochrane Library、EMbase、Web of Science、CNKI、WanFang Data、CBM 和 VIP,搜集肝癌筛查的诊断性试验,检索时限均从 1980 年 1 月至 2017 年 12 月。由 2 名研究员独立筛选文献、提取资料,并评价纳入研究的偏倚风险后,采用 Meta-Disc1.4 软件行 Meta 分析。 结果 最终纳入 54 个研究,包括 47 728 例患者。Meta 结果显示,单独血清甲胎蛋白筛查(AFP)不同截断值(20 ng/mL、200 ng/mL 和 400 ng/mL)筛查肝癌的 Sen合并 分别为 0.71[95%CI(0.70,0.72)]、0.57[95%CI(0.56,0.59)]和 0.43[95%CI(0.41,0.45)],Spe合并 分别为 0.92[95%CI(0.92,0.93)]、0.95[95%CI(0.94,0.96)]和 0.95[95%CI(0.94,0.96),+LR合并 分别为 5.65[95%CI(4.37,7.30)]、13.24[95%CI(4.25,41.22)]和 11.39[95%CI(4.01,32.35)],–LR合并 分别为 0.35[95%CI(0.31,0.39)]、0.38[95%CI(0.29,0.52)]和 0.49[95%CI(0.39,0.62)],DOR 分别为 17.23[95%CI(12.26,24.20)]、33.79[95%CI(12.65,90.24)]和 24.41[95%CI(9.23,64.53)];单独肝脏超声筛查肝癌的 Sen合并、Spe合并、+LR合并、–LR合并、DOR 分别为 0.65[95%CI(0.62,0.69)]、0.97[95%CI(0.97,0.97)]、16.48[95%CI(9.55,28.42)]、0.27[95%CI(0.18,0.42)]和 64.54[95%CI(30.16,138.11)];AFP-20 联合超声筛查肝癌的 Sen合并、Spe合并、+LR合并、–LR合并、DOR 分别为 0.96[95%CI(0.94,0.98)]、0.96[95%CI(0.96,0.96)]、10.76[95%CI(2.62,44.27)]、0.07[95%CI(0.02,0.22)]和 160.59[95%CI(31.61,816.03)]。 结论 单独血清甲胎蛋白筛查以 20 ng/mL 为阈值时诊断价值最佳,其联合超声检查的筛查方案,可大幅提高诊断灵敏度,适用于高危人群筛查。

Objective To evaluate the accuracy of liver cancer screening techniques to inform screening intervention and early diagnosis. Methods We searched PubMed, The Cochrane Library, EMbase, Web of Science, CNKI, WanFang Data, CBM, VIP databases to collect relevant diagnostic accuracy studies of screening technologies for liver cancer from January 1980 to December 2017. Two reviewers independently screened the literature, extracted the data and assess the risk of bias of included studies. Then meta-analysis was performed by using Meta-Disc 1.4 software. Results A total of 54 publications with 47 728 individuals were included. In terms of pooled sensitivity from the meta-analysis, it was estimated as 0.71 (95%CI 0.70 to 0.72), 0.57 (95%CI 0.56 to 0.59) and 0.43 (95%CI 0.41 to 0.45); the pooled specificity was estimated as 0.92 (95%CI 0.92 to 0.93), 0.95 (95%CI 0.94 to 0.96) and 0.95 (95%CI 0.94 to 0.96); the pooled positive likelihood ratio was 5.65 (95%CI 4.37 to 7.30), 13.24(95%CI 4.25 to 41.22) and 11.39 (95%CI 4.01 to 32.35); the pooled negative likelihood ratio was 0.35 (95%CI 0.31 to 0.39), 0.38 (95%CI 0.29 to 0.52) and 0.49 (95%CI 0.39 to 0.62); the diagnosis odds ratio was 17.23 (95%CI 12.26 to 24.20), 33.79 (95%CI 12.65 to 90.24) and 24.41(95%CI 9.23 to 64.53) for AFP alone @20, @200 and 400 ng/mL respectively. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnosis odds ratio were 0.65 (95%CI 0.62 to 0.69), 0.97 (95%CI 0.97 to 0.97), 16.48 (95%CI 9.55 to 28.42), 0.27 (95%CI 0.18 to 0.42) and 64.54 (95%CI 30.16 to 138.11) for ultrasound examination alone. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnosis odds ratio were 0.96 (95%CI 0.94 to 0.98), 0.96 (95%CI 0.96 to 0.96), 10.76 (95%CI 2.62 to 44.27), 0.07 (95%CI 0.02 to 0.22) and 160.59 (95%CI 31.61 to 816.03) for the combined strategy. Conclusion For liver cancer screening technologies, the overall accuracy of serum AFP test alone was the best at cut-off of 20 ng/mL, and the sensitivity increased substantially when combined with ultrasound examination.

关键词: 肝癌; 甲胎蛋白; 超声; 筛查; 诊断性试验; Meta 分析

Key words: Liver cancer; Alpha-Fetoprotein; Ultrasonography; Screening; Diagnostic test; Meta-analysis

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