血清铁蛋白诊断乳腺癌准确性的Meta分析

Accuracy of Serum Ferritin for Breast Cancer:A Meta-Analysis

目的系统评价血清铁蛋白诊断乳腺癌的准确性。方法计算机检索CNKI、Wan Fang Data、CBM、VIP、Pub Med、EMbase、h e Cochrane Library（2013年第5期）,查找有关血清铁蛋白诊断乳腺癌的诊断性试验,检索时限均为从建库至2014年4月10日。由4位评价者按照纳入与排除标准独立筛选文献、提取资料并评价纳入研究的方法学质量后,采用Meta-Disc 1.4软件进行Meta分析,并采用Stata 12.0软件绘制漏斗图和评估发表偏倚。结果最终纳入19个研究,共计2 977例患者。Meta分析结果显示：1血清铁蛋白诊断乳腺癌的合并敏感度（Sen）、特异度（Spe）、阳性似然比（＋LR）、阴性似然比（–LR）、诊断比值比（DOR）分别为0.51[95%CI（0.48,0.53）]、0.91[95%CI（0.89,0.92）]、5.32[95%CI（3.72,7.60）]、0.45[95%CI（0.35,0.57）]、13.22[95%CI（7.22,24.18）];SROC曲线下面积AUC=0.920 5,Q＊指数为0.853 9。2界值在101~150μg/L时的Sen、Spe、AUC和Q＊指数最大,最佳临界值为150μg/L的可能性大。结论血清铁蛋白在乳腺癌的诊断中具有较高的Sen及Spe,但不能作为诊断乳腺癌的特异指标。各研究结果间均存在统计学异质性,可能与研究者、病情严重程度、仪器类型、试剂来源及临界值有关。受纳入研究的质量与数量所限,上述结论仍需谨慎看待,在临床中应与其他肿瘤标志物联合检测来增加准断乳腺癌的准确性。

Objective To systematically review the accuracy of serum ferritin（SF） for detecting breast cancer. Methods We electronically and comprehensively searched databases including CNKI,Wan Fang Data,CBM,VIP,Pub Med,EMbase and the Cochrane Library（Issue 5,2013） up to April 2013,for diagnostic tests about using SF for detecting breast cancer. Four reviewers independently screened literature according to the exclusion and inclusion criteria,extracted data,and assessed methodological quality of included studies. h en,meta-analysis was performed using Meta-Disc 1.4 sot ware and funnel plots were drawn using Stata 12.0 sot ware. Results A total of 19 studies were i nally included involving 2 977 patients. h e results of meta-analysis showed that： Sen,Spe,＋LR,–LR,DOR were 0.51（95%CI 0.48 to 0.53）,0.91（95%CI 0.89 to 0.92）,5.32（95%CI 3.72 to 7.60）,0.45（95%CI 0.35 to 0.57）,and 13.22（95%CI 7.22 to 24.18）; SROC area under the curve（AUC） was 0.920 5 and Q^＊ was 0.853 9. Besides,when cut of value was 101-150 μg/L,Sen,Spe,AUC and Q^＊ were the largest,and the best cut-of value was probably 150 μg/L. Conclusion SF has relatively high Sen and Spe in the diagnosis of breast cancer which could not be used as specii cfindex. Heterogeneities exist among the research results,which are possibly associated with researchers,severity of disease,instrument types,sources of reagents,and cut of values. Due to limited quality and quantity of the included studies,the above conclusion should be treated with caution,and in clinic,combing other tumour markers with SF is recommended in detecting breast cancer to augment accuracy.