AFP和DCP单项与联合检测对原发性肝癌诊断价值的Meta分析

Diagnostic value of AFP and DCP in primary hepatocellular carcinoma with single and combined detection:a Meta-analysis

目的系统评价甲胎蛋白(AFP)和异常凝血酶原(DCP)单项与联合检测在原发性肝癌(PHC)中的诊断价值。方法检索Cochrane Library、Embase、PubMed、PML、中国知网、万方医学数据库以及维普中文数据库获取AFP和DCP单项与联合检测诊断PHC的文献,依据纳入和排除标准筛选文献并提取数据。利用诊断性研究质量评价量表对纳入的文献进行质量评价,并采用Meta-DiSc1.4软件和Stata15.0软件对研究指标进行Meta分析。结果共纳入中英文文献45篇。AFP单项检测汇总的灵敏度、特异度、诊断比值比(DOR)分别为0.67(95%CI:0.66~0.69)、0.82(95%CI:0.81~0.83)、11.58(95%CI:9.02~14.86);DCP单项检测汇总的灵敏度、特异度、DOR分别为0.76(95%CI:0.75~0.77)、0.87(95%CI:0.86~0.88)、29.07(95%CI:21.86~38.64);AFP和DCP联合检测汇总的灵敏度、特异度、DOR分别为0.85(95%CI:0.84~0.86)、0.79(95%CI:0.78~0.80)、30.03(95%CI:22.09~40.82)。AFP、DCP单项检测与AFP和DCP联合检测的受试者工作特征曲线下面积(AUC)分别为0.82、0.89、0.92。Z检验显示,AFP单项检测与DCP和AFP联合检测的AUC间差异有统计学意义(P<0.05)。结论联合检测血清AFP和DCP能显著提高PHC的诊断准确性,能有效避免一些由AFP单项检测造成的假阴性病例,有助于早期诊断PHC。

Objective To evaluate the diagnostic value of alpha-fetoprotein(AFP)and des-gamma-carboxy-prothrombin(DCP)alone and combined detection in primary hepatocellular carcinoma(PHC).Methods Literatures of AFP,DCP alone and combined detection for diagnosing PHC were obtained through searching Cochrane Library,Embase,PubMed,PML,CNKI,Wanfang database,VIP database.Literatures were screened according to the inclusion and exclusion criteria and data were extracted.Quality of included literatures was evaluated by quality assessment of diagnostic accuracy studies.Meta-analysis was employed by Meta-DiSc1.4 and Stata15.0.Results Totally 45 literatures in Chinese or English were included.The polled sensitivity,specificity,diagnostic test odds ratio(DOR)and 95%CI of AFP alone were 0.67(95%CI:0.66—0.69),0.82(95%CI:0.81—0.83),11.58(95%CI:9.02—14.86);and for those of DCP alone were 0.76(95%CI:0.75—0.77),0.87(95%CI:0.86—0.88),29.07(95%CI:21.86—38.64);while for those of AFP combined with DCP were 0.85(95%CI:0.84-0.86),0.79(95%CI:0.78-0.80),30.03(95%CI:22.09-40.82).The area under receiver operating curve(AUC)of AFP,DCP and AFP combined with DCP were 0.82,0.89 and 0.92,respectively.Significant statistically difference in the AUC between the AFP and AFP combined with DCP was found by Z test(P<0.05).Conclusion The combined detection of AFP and DCP can improve the diagnostic accuracy for PHC,and it can avoid some false negative PHC cases caused by detecting AFP alone.This will be good for diagnosing PHC early.