血清异常凝血酶原对原发性肝癌诊断准确性荟萃分析

Accuracy of des-γ-carboxy prothrombin(DCP) for diagnosis of primary hepatocellular cancer:a Meta-analysis

目的采用荟萃(meta)分析方法系统评价血清异常凝血酶原(des-γ-carboxy-prothrombin,DCP)在原发性肝癌诊断中的准确性。方法全面检索建库至2016年12月有关DCP对原发性肝癌的诊断性研究,最终纳入文献17篇,累计原发性肝癌病例1 970例,对照组2 588例(包括慢性肝炎、肝硬化、其他系统肿瘤以及体检健康者),用Stata 12.0软件进行meta分析。结果各效应量在95%CI下的敏感性(SEN_(DCP))=0.79(0.74~0.83);特异性(SPE_(DCP))=0.90(0.87~0.93);阳性似然比(PLR_(DCP))=8.1(5.8~11.1);阴性似然比(NLR_(DCP))=0.24(0.19~0.29);诊断比值比(DOR_(DCP))=34(21~55);SROC曲线下面积(AUC_(DCP)^(ROC))=0.91(0.89~0.93)。DCP和AFP联合检测SEN_(联合)=0.90,SPE_(联合)=0.86,AUC_(联合)^(ROC)=0.94,DOR_(联合)=56。结论血清DCP单独检测诊断原发性肝癌具有较高特异性,与AFP联合检测可提高诊断敏感性和准确性。

Objective To carry out a systematic evaluation for the diagnostic accuracy of Des-γ-carboxy-prothrombin（DCP） in primary hepatocellular cancer（PHC） by Meta-analysis. Methods The published international and domestic studies on DCP in the diagnosis of PHC were searched in multiple databases from its inception until December 2016. A total of seventeen studies were finally selected, a- mong which 1 970 cases of PHC group and 2 588 cases of control group were included. The control group was composed of chronic hep- atitis, cirrhosis, tumors in other systems and healthy subjects with physical examination. A meta-analysis was performed using Stata 12.0. Results The overall pooled results of the analysis and the 95% confidence intervals were as follows ： the sensitivity（SEN） was 0.79 （0.74 to 0.83 ）, the specificity （SPE） was 0.90 （0.87 to 0.93）, the positive likelihood ratio （PLR） was 8.1 （5.8 to 11.1 ）, the negative likelihood ratio （NLR） was 0.24 （0.19 to 0.29）, the diagnostic odds ratio （DOR） was 34 （21 to 55 ） and the area under the summary receiver operator characteristic curve （SROC） was 0.91 （0.89 to 0.93 ）. The sensitivity combined the detections of AFP and DCP in the diagnosis of PHC was 0.90 with 0.94 of AUCsc and 56 of DOR. Conclusion The serum DCP may exhibit a relatively higher diagnostic specificity for PHC. The combined detections of AFP and DCP could improve the sensitivity and diagnostic accuracy.