尿液HE4和血清HE4诊断卵巢癌的Meta分析

Meta analysis of urine HE4 and serum HE4 in the diagnosis of ovarian cancer

目的探讨尿液人附睾蛋白4(HE4)和血清HE4对卵巢癌的诊断价值。方法检索国内外数据库,搜集HE4在尿液和血清中对卵巢癌诊断试验的相关文献,检索时限均为从建库至2020年10月。由两名研究者根据纳入及排除标准独立筛选文献、提取资料,根据QUADAS-2对纳入文献进行偏倚风险评估后采用Meta-Disc1.4软件进行Meta分析。结果最终纳入7篇文献,Meta分析结果显示,尿液HE4诊断卵巢癌的SEN=0.84[95%CI(0.79~0.88)]、SPE=0.94[95%CI(0.92~0.96)]、SROC AUC=0.9428;血清HE4诊断卵巢癌的SEN=0.76[95%CI(0.70~0.80)]、SPE=0.90[95%CI(0.87~0.93)]、SROC AUC=0.9017;FIGO分期Ⅰ/Ⅱ期的血清HE4表达水平低于Ⅲ/Ⅳ期(P<0.05);黏液性卵巢癌中尿液HE4和血清HE4的表达水平均高于浆液性卵巢癌(P<0.05)。结论相较于血清HE4,尿液HE4具有较高的灵敏度、特异度和SROC AUC,诊断效能更高。两者对浆液性卵巢癌和黏液性卵巢癌有同样的预测价值,但血清HE4对术前判断患者分期优于尿液HE4。

Objective To explore the diagnostic value of urine human epididymis protein 4(HE4)and serum HE4 for ovarian cancer.Methods Domestic and foreign databases were searched to collect the relevant literatures about HE4 in urine and serum for the diagnosis of ovarian cancer.The retrieval time was from the establishment of the database to October 2020.Two researchers independently screened the literature according to the inclusion and exclusion criteria,extracted data,assessed the bias risk of the included literatures according to QUADAS-2,and then used Meta-Disc1.4 software for Meta analysis.Results A total of 7 literatures were included.The results of Meta analysis showed that SEN,SPE,SROC AUC of urine HE4 in the diagnosis of ovarian cancer were 0.84[95%CI(0.79-0.88)],0.94[95%CI(0.92-0.96)]and 0.9428,respectively;SEN,SPE,SROC AUC of serum HE4 in the diagnosis of ovarian cancer were 0.76[95%CI(0.70-0.80)],0.90[95%CI(0.87-0.93)]and 0.9017,respectively;the expression level of serum HE4 in FIGO stageⅠ/Ⅱwas lower than that in FIGO stageⅢ/Ⅳ(P<0.05);the expression levels of HE4 in urine and serum in mucinous ovarian cancer were higher than those in serous ovarian cancer(P<0.05).Conclusion Compared with serum HE4,urine HE4 has a higher sensitivity,specificity,SROC AUC and diagnostic efficiency.Both of them have the same predictive value for serous ovarian cancer and mucinous ovarian cancer,but serum HE4 is better than urine HE4 for the evaluation of preoperative staging.