女性自取样和医生取样检测人乳头瘤病毒在宫颈癌筛查中的荟萃分析

Meta Analysis of the Human Papilloma Virus Detection in Cervical Cancer Screening by Self-sampling of Female and Clinician-sampling

本研究通过检索PubMed、Embased等相关的数据库,对2019年8月31日之前有关宫颈癌筛查自取样的文献进行筛选。根据纳入、排除标准确定相关文献,使用随机效应模型汇总CIN2+和CIN3+样本的加权灵敏度、特异度,绘制汇总受试者工作特征曲线,并计算Q^(*)值,比较分析自取样与临床医生取样检测人乳头瘤病毒(human papilloma virus,HPV)评价宫颈疾病的效能。总共收集了255392例研究样本。宫颈疾病以病理学诊断CIN和宫颈癌的结果为金标准。对于CIN2+的样本中,自取样检测HPV评价宫颈疾病的汇总灵敏度为81%,汇总特异度为87%;临床医生取样汇总灵敏度为92%,汇总特异度为86%。对于CIN3+样本中,自取样的汇总灵敏度为84%,汇总特异度为83%;临床医生取样的汇总灵敏度为94%,汇总特异度为85%。此外,亚组分析结果显示:对于CIN2+样本,HPV检测方法在自取样样本中准确性最高的为HPV PCR GP5+/6+,而在临床医生取样样本中准确性最高的为Hybrid Capture 2。综上,临床医生取样检测HPV评价宫颈疾病更为准确,大规模的宫颈癌筛查更需要选择医生取样。自取样方法仅可应用于那些初次筛查或者条件有限地区女性的补充筛查策略,并且需要使用基于PCR类等高灵敏度技术检测HPV来弥补自取样的不足。

In this study,we searched PubMed,Embased and other related databases to screen the literature on cervical cancer screening self-collected samples before August 31,2019.According to the inclusion and exclusion criteria,this study determined the relevant literature,used the random effects model to summarize the pooled sensitivity and specificity of CIN2+and CIN3+samples,drew the summary receiver operating characteristic curve,and calculated the Q^(*)value,compare and analyze self-collected samples and clinician-collected samples to detect Human Papilloma Virus for evaluating the efficacy of cervical disease.A total of 255392 study samples were collected.Cervical diseases were based on the pathological diagnosis of CIN and cervical cancer as the gold standard.For the CIN2+samples,the pooled sensitivity of self-collected samples detection of HPV in evaluating cervical diseases was 81%,and the pooled specificity was 87%;the pooled sensitivity of the clinician-collected samples was 92%,and the pooled specificity was 86%.For the CIN3+sample,the pooled sensitivity of self-collected samples was 84%,and the pooled specificity was 83%;the pooled sensitivity of the clinician-collected samples was94%,and the pooled specificity was 85%.In addition,the results of subgroup analysis showed that for CIN2+samples,the HPV detection method with the highest accuracy in self-collected samples was HPV PCR GP5+/6+,and the highest accuracy in clinician-collected samples was Hybrid Capture 2.In summary,it is more accurate for clinicians to take samples to detect HPV to evaluate cervical diseases,and large-scale cervical cancer screening requires more selection of doctors to take samples.The self-collected method can only be applied to supplementary screening strategies for women in areas where conditions are limited or for the first time,and high-sensitivity technologies such as PCR-based detection of HPV are required to make up for the lack of self-collected samples.