TK1在肺癌中的诊断价值的Meta分析

The diagnostic value of the expression of the thymidine kinase 1 in lung cancer:A meta analysis

目的:通过文献回顾和Meta分析,探究胸苷激酶1(thymidine kinase 1,TK1)在肺癌诊断中的价值。方法:首先检索Pubmed、Embase、Cochrane、Web of Science、中国生物医学文献数据库(CBM)、中国知网、万方等数据库,并获取截止日期在2022年06月之前的文献。由两名研究者单独筛选报道TK1在肺癌诊疗中的相关临床研究,并获取文献全文。其次,通过使用Revman5.3软件对文献进行系统质量评价和偏倚风险评估,并对各协变量之间的一致性进行评价。最后,通过使用Stata16.0软件将灵敏度(sensitivity,Sen)、特异度(specificity,Spe)等指标进行汇总分析。结果:本研究共纳入37篇文献,其中包含3218例肺癌病例和2976例对照病例,在此基础上进行Meta分析,结果显示,TK1单独作为肺癌诊断指标时,Sen=0.63(95%CI:0.57,0.68),Spe=0.88(95%CI:0.84,0.91),阳性似然比(positive likelihood ratio,PLR)为5.34(95%CI:4.02,7.1),阴性似然比(negative likelihood ratio,NLR)为0.42(95%CI:0.37,0.48),诊断比值比(diagnostic odds ratio,DOR)为12.69(95%CI:8.91,18.08),受试者工作曲线下面积(area under the ROC curve,AUC)为0.82(95%CI:0.79,0.85)。TK1、CEA及CYFRA21⁃1作为肺癌联合诊断指标时,Sen=0.82(95%CI:0.76,0.86),Spe=0.78(95%CI:0.46,0.94),PLR=3.69(95%CI:1.28,10.66),NLR=0.24(95%CI:0.18,0.31),DOR=15.59(95%CI:4.56,53.36),AUC=0.84(95%CI:0.80,0.87);联合诊断的Youden指数为0.60,大于TK1单独诊断时的0.55。结论:TK1单独作为肺癌诊断指标时灵敏度偏低,但特异度较高,具有一定的诊断价值;TK1与CEA、CYFRA21⁃1联合诊断肺癌时有更高的灵敏度,诊断真实性高于TK1单独作为诊断指标时,诊断价值更佳。

Objective:To study is to evaluate the diagnostic value of the expression of thymidine kinase 1(TK1)in lung cancer through literature review and meta⁃analysis.Methods:Firstly,we searched Pubmed,Embase,Cochrane,Web of Sci⁃ence,CBM,CNKI,Wanfang and other databases up to June 2022.Then two researchers separately selected the clinical study on diagnosis of lung cancer by the expression of the TK1 and treatment and obtained the full text of the literature.Then we evaluated the systematic quality and bias risk of the included literatures by using Revman 5.3 software,and the consistency among the covari⁃ables in meta analysis.Finally,the Sensitivity(Sen),the Specificity(Spe)and other indicators were analyzed by using Stata16.0 software.Results:The study included 37 literatures,including 3218 lung cancer cases and 2976 control cases.The meta⁃analysis showed that the Ser and Spe of the expression of the TK1 in the diagnosis of lung cancer were 0.63(95%CI:0.57,0.68)and 0.88(95%CI:0.84,0.91),while positive likelihood ratio(PLR)was 5.34(95%CI:4.02,7.1)and negative likelihood ratio(NLR)was 0.42(95%CI:0.37,0.48),diagnostic odd sratio(DOR)was 12.69(95%CI:8.91,18.08),and the area under the ROC curve(AUC)was 0.82(95%CI:0.79,0.85).When TK1,CEA and CYFRA21⁃1 were used as combined diagnostic indexes of lung cancer,Sen was 0.82(95%CI:0.76,0.86),Spe 0.78(95%CI:0.46,0.94),PLR 3.69(95%CI:1.28,10.66),NLR 0.24(95%CI:0.18,0.31),DOR 15.59(95%CI:4.56,53.36),AUC 0.84(95%CI:0.80,0.87).The Youden index of combined di⁃agnosis was 0.60,which was higher than that of TK1 alone.Conclusion:TK1 alone as a diagnostic index of lung cancer has low Sen,but its Sep is higher.So it has a certain diagnostic value.TK1 combined with CEA and CYFRA21⁃1 has higher Sen in the di⁃agnosis of lung cancer,and the diagnostic value is better.