人附睾蛋白4早期诊断子宫内膜癌价值的系统评价

Human Epididymis Protein 4 in Early Diagnosis of Endometrial Cancer: A Systematic Review

目的系统评价人附睾蛋白4(HE4)在子宫内膜癌早期诊断中的价值。方法计算机检索h e Cochrane Library(2013年第1期)、PubMed、MEDLINE(Ovid)、CNKI、CBM及WanFang Data等数据库,并手工检索相关杂志,全面收集HE4与金标准(病理诊断)比较早期诊断子宫内膜癌的相关文献,检索时限均为从建库至2013年4月。按照纳入和排除标准筛选文献和提取资料后,采用QUADAS标准评价纳入文献质量,使用RevMan5.1软件和Meta-DiSc 1.0软件进行Meta分析。结果最终纳入16个研究,共2299例受试者,其中包括1088例经金标准确诊的子宫内膜癌患者、504例子宫良性疾病患者和707例正常妇女。Meta分析结果显示:HE4诊断子宫内膜癌的SEN合并=57%[95%CI(0.54,0.60)],SPE合并=92%[95%CI(0.91,0.94)],+LR合并=6.92[95%CI(5.00,9.58)],–LR合并=0.46[95%CI(0.39,0.55)],DOR合并=18.38[95%CI(12.21,27.69)],AUC=0.8817。结论现有研究显示血清HE4对子宫内膜癌总体诊断敏感度较低,但特异度较高,HE4在子宫内膜癌早期诊断中具有较大临床应用价值。但受纳入研究质量不高所限,上述结论尚需要高质量研究予以证实。

ObjectiveTo systematically review the value of human epididymis protein 4 （HE4） in early diagnosis of endometrial cancer. MethodsDatabases including The Cochrane Library （Issue 1, 2013）, PubMed, MEDLINE （Ovid）, CNKI, CBM and WanFang Data were electronically searched for relevant studies on HE4 versus the golden standard （pathological examination） in the diagnosis of endometrial cancer from inception to April 2013. Meanwhile, relevant journals were also manually searched. Two reviewers independently screened literature according to the inclusion and exclusion criteria, and evaluated the included studies using the QUADAS items. Then, meta-analysis was performed using RevMan 5.1 and Meta-DiSc 1.0. ResultsFinally, a total of 16 studies involving 2 299 women （1 088 endometrial cancer patients diagnosed according to the golden standard, of which, 504 with benign uterine disease and 707 with normal cervical） were included. The results of meta-analysis showed that, as for HE4 in early diagnosis of endometrial cancer （SEN=57%, 95%CI 0.54 to 0.60; SPE=92%, 95%CI 0.91 to 0.94; ＋LR=6.92, 95%CI 5.00 to 9.58; –LR=0.46, 95%CI 0.39 to 0.55; DOR=18.38, 95%CI 12.21 to 27.69; AUC=0.881 7）. ConclusionThe current study indicates that serum HE4 is more sensitive and low specific when applied in patients with endometrial cancer, which is worth of being used in clinic. Due to the limitation of low quality of the included studies, more high quality trials are required to verify the above conclusion.