端粒酶活性检测对胰腺癌的早期诊断价值

Early diagnostic value of telomerase activity for pancreatic cancer： a meta-analysis

目的 探讨端粒酶活性检测对胰腺癌的早期诊断价值.方法 检索早期经胰液、胰管刷取物、针吸组织细胞等样本检测端粒酶活性诊断胰腺癌的研究文献.筛选文献并提取纳入研究中有关准确度的数据.采用Meta-DiSc1.4软件进行Meta分析.结果 共纳入文献12篇,经异质性检验无阈值效应 Meta回归分析表明实验盲法、不同样本间无异质性,不同检测方法是纳入研究间异质性的主要来源.进一步亚组分析,TRAP法检测端粒酶活性早期诊断胰腺癌的敏感度、特异度分别为0.86（95%CI：0.78～0.91）、0.78（95%CI：0.68～0.87）,综合受试者工作特征曲线下面积（AUC）=0.9005,Q＊=0.8318 TRAP-ELISA法检测的上述指标分别为0.72（95%CI：0.63～0.79）、0.63（95%CI：0.47～0.77）,AUC=0.7634,Q＊=0.7046.结论 端粒酶活性检测对胰腺癌的早期诊断价值中等,可以作为胰腺癌早期诊断或筛查可选的检查方法,单独作为诊断指标尚有不足.

Objective To systematically assess the early diagnostic value of telomerase activity for pancreatic cancer. Methods A comprehensive searching was performed to retrieve relevant diagnostic studies on telomerase activity in pancreatic cancer from pancreatic juice, pancreatic duct brushing and fineneedle aspiration. Data on accuracy of included studies were extracted for further meta-analysis using MetaDiSc1.4 software. Results Twelve studies met the inclusion criteria, in which there was no threshold effect. Heterogeneity was not found from blind experimental designs and different samplings, but from different test methods within these studies by using Meta-regression analysis. A meta-analysis of subgroup was performed. In TRAP group, pooled accuracy indicators like sensitivity, specificity were 0. 86 （0. 78-0. 91 ）, 0. 78 （0. 68-0. 87） respectively, area under curve （AUC） of summary receiver operating characteristics （SROC） curve was 0. 8368 and Q index was 0. 7689. In TRAP-ELISA group, the same pooled accuracy indicators were 0. 72 （0. 63-0. 79）, 0. 63 （0. 47-0. 77） respectively, AUC was 0. 7634, and Q index was 0. 7046. Conclusion This meta-analysis demonstrated that the early diagnostic value of telomerase activity is moderate for pancreatic cancer. At present, it can be an optional examination of early diagnosis and screening for pancreatic cancer, instead of an independent indicator.