TCT联合HPV E6/E7 mRNA检测对子宫颈癌前早期病变诊断价值的meta分析

Meta-analysis on value of TCT combined with HPV E6/E7 mRNA detection in diagnosis of cervical precancerous lesions

目的系统评价液基薄层细胞学检查(thinprep cytologic test,TCT)联合人乳头瘤病毒(human papillomavirus,HPV)E6/E7 mRNA检测对子宫颈癌前早期病变的诊断价值。方法计算机检索CNKI、维普数据库(VIP)、万方数据库、中国生物医学文献数据库(CBM)、PubMed、The Cochrane Library、Embase、Science数据库中关于TCT联合HPV E6/E7 mRNA检测诊断子宫颈癌前早期病变的相关文献,检索时限均为建库至2023年1月。由2位评价员按纳入标准和排除标准各自筛选文献、提取资料和评价质量后,采用RevMan 5.3、Stata 15.0、Meta-Disc 1.4统计软件分析TCT联合HPV E6/E7 mRNA检测对子宫颈癌前早期病变的诊断价值,计算诊断敏感性的Spearman相关系数验证阈值效应,进行异质性检验ꎻ计算合并敏感性、特异性、阳性似然比和阴性似然比、诊断比值比、SROC曲线下面积。结果共纳入15篇文献,合计6620例患者。Meta分析显示,合并敏感性、特异性、阳性似然比、阴性似然比、诊断比值比均不存在明显异质性(I2=31.6%、14.2%、10.9%、16.7%、17.2%,P=0.1162、0.2947、0.3311、0.2663、0.2610),采用固定效应模型进行统计分析,其结果分别为0.95(95%CI:0.94~0.96)、0.87(95%CI:0.86~0.88)、6.86(95%CI:6.26~7.51)、0.06(95%CI:0.05~0.07)、113.23(95%CI:86.44~148.31)。SROC曲线下面积为0.9414。结论TCT联合HPV E6/E7 mRNA检测对诊断子宫颈癌前早期病变有重要价值。

Objective To systematically evaluate the diagnostic value of thinprep cytology test(TCT)combined with human papillomavirus(HPV)E6/E7 mRNA detection in early precancerous lesions of the cervix.Methods The relevant documents about TCT combined with HPV E6/E7 mRNA detection in diagnosing cervical precancerous early lesions which published in CNKI,VIP database,Wanfang database,China Biomedical Literature Database(CBM),PubMed,The Cochrane Library,Embase,Science database were searched by computer.The search time limit was from the establish of these data bases till January 2023.Two evaluators screened the literatures,extracted the data and evaluated the quality according to the inclusion criteria and exclusion criteria,then the diagnostic value of TCT combined with HPV E6/E7 mRNA detection for cervical precancerous early lesions was analyzed by using RevMan 5.3,Stata 15.0,Meta-Disc 1.4 statistical software,and the Spearman correlation coefficient of diagnostic sensitivity was calculated to verify the threshold effect,and the heterogeneity test was performed,and alculated the combined sensitivity,specificity,positive likelihood ratio and negative likelihood ratio,diagnostic odds ratio,and area under the SROC curve.Results A total of 15 articles were screened,including 6,620 patients.Meta analysis showed that there were no significant heterogeneity in the aspects of combined sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio(I2=31.6%,14.2%,10.9%,16.7%,17.2%,P=0.1162,0.2947,0.3311,0.2663,0.2610).Statistical analysis was carried out using fixed effect model,and the results were 0.95(95%CI:0.94~0.96),0.87(95%CI:0.86~0.88),6.86(95%CI:6.26~7.51),0.06(95%CI:0.05~0.07),113.23(95%CI:86.44~148.31).The area under the SROC curve was 0.9414.Conclusions TCT combined with HPV E6/E7 mRNA detection has important value in the diagnosis of early cervical precancerous lesions.