HPV DNA与HPV E6/E7 mRNA检测筛查宫颈高级别病变的Meta分析

A Meta Analysis about The Screening of Cervical Intraepithelial Neoplasia Grade 2 or Worse between The HPV DNA Test and HPV E6/E7 mRNA Test

目的评价HPV DNA与HPV E6/E7 mRNA两种检测方法对宫颈高级别病变的筛查价值。方法检索Cochrane图书馆、PubMed、EMBASE、CNKI、万方、维普数据库,收集2010年1月至2018年1月发表的利用HPV DNA或HPV E6/E7 mRNA检测进行宫颈癌或癌前病变筛查的文献。根据文献纳入及排除标准进行文献筛选,应用Meta分析软件比较HPV DNA与HPV E6/E7 mRNA检测对宫颈高级别病变的筛查价值。结果最终共纳入8篇文献,HPV DNA与HPV E6/E7 mRNA检测诊断宫颈高级别病变的汇总敏感度分别为0.91(95%可信区间为0.88~0.93)和0.87(95%可信区间为0.84~0.90),汇总特异度分别为0.65(95%可信区间为0.62~0.67)和0.82(95%可信区间为0.80~0.83)。HPV DNA与HPV E6/E7 mRNA检测诊断宫颈高级别病变的曲线下面积分别为0.875 2和0.883 5,Q*统计量分别为0.805 6和0.814 0,Z=2.34,P<0.05,差异有统计学意义。结论HPV E6/E7 mRNA与HPV DNA两种检测方法对宫颈高级别病变的诊断敏感度和诊断效能相当,但HPV E6/E7 mRNA的特异度相对更高,可以更好地平衡筛查的利益和风险。

Objective To compare the predictive value of HPV DNA and HPV E6/E7 mRNA to triage CIN2+lesion in cervical cancer screening by meta-analysis.Methods All literatures in the Cochrane library,PubMed,EMBASE,CNKI,Wanfang,VIP database from January 2010 to January 2018 were collected according to strigent selection standard,including cervical cancer screening with HPV DNA test and HPV E6/E7 mRNA test.Meta analysis was made by software to compare the value between HPV DNA test and HPV E6/E7 mRNA test in screening lesions of CIN2+.Result Eight studies were included in the meta-analysis.The pooled sensitivity of HPV DNA and HPV E6/E7 mRNA for detecting CIN2+were 0.91(95%CI 0.88~0.93)and 0.87(95%CI 0.84~0.90),and the pooled specificity were 0.65(95%CI 0.62~0.67)and 0.82(95%CI 0.80~0.83).The AUC of HPV DNA test and HPV E6/E7 mRNA tset for detecting CIN2+were 0.875 2 and 0.883 5 respectively,the Q*value of HPV DNA test and HPV E6/E7 mRNA test were 0.805 6 and 0.814 0(Z=2.34,P<0.05).There was statistical significance between these two methods.Conclusion Compared with HPV DNA test,HPV E6/E7 mRNA test has comparable sensitivity and similar discrimination ability,but higher specificity,which will balance the risk and benefit during cervical cancer screening better.