脱-γ-羧基凝血酶原诊断原发性肝癌的系统评价

Des-γ-carboxy prothrombin in the diagnosis of primary hepatocellular carcinoma: a systematic review

目的系统评价血清脱-γ-羧基凝血酶原(des-γ-carboxy prothrombin,DCP)诊断原发性肝癌(primary hepatocellular carcinoma,PHC)的诊断价值。方法计算机检索PubMed、The Cochrane Library、EMbase、Medline(Ovid)、CNKI、VIP、WanFang Data和CBM数据库,搜集DCP诊断PHC的相关研究,检索时限均从建库至2018年12月31日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件和Meta Disc 1.4软件进行Meta分析。结果共纳入50个研究,包括15 099例患者。Meta分析结果显示:血清DCP诊断PHC的合并敏感度、特异度、阳性似然比、阴性似然比、诊断比值比和SROC曲线下面积分别为:0.69[95%CI(0.67,0.70)]、0.89[95%CI(0.89,0.90)]、7.35[95%CI(6.08,8.90)]、0.31[95%CI(0.27,0.35)]、26.63[95%CI(20.42,34.73)]和0.909 9。结论血清DCP对PHC具有较高的诊断效能,尤其诊断的特异度较高。受纳入研究的数量和质量的限制,上述结论尚需开展更多研究予以证实。

Objective To systematically review clinical value of des-γ-carboxy prothrombin(DCP) in the diagnostic of primary hepatocellular carcinoma(PHC). Methods Databases including PubMed, The Cochrane Library,EMbase, Medline(Ovid), CNKI, VIP, WanFang Data and CBM were electronically searched to collect relevant studies on DCP in the diagnosis of PHC from inception to December 31 st, 2018. Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using Meta-Disc 1.4 software and RevMan 5.3 software. Results A total of 50 studies involving 15 099 cases were included. The results of meta-analysis showed that the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic odds ratio and area under the curve of SROC were 0.69(95%CI 0.67 to 0.70), 0.89(95%CI 0.89 to 0.90), 7.35(95%CI 6.08 to 8.90), 0.31(95%CI 0.27 to 0.35), 26.63(95%CI 20.42 to 34.73) and 0.909 9,respectively. Conclusions Serum DCP has higher diagnostic efficacy for PHC, especially with higher specificity of diagnosis. Due to the limited quality and quantity of included studies, the above results should be validated by more studies.