TGFβ1对原发性肝癌诊断价值的Meta分析

摘要

Objective To investigate the value of transforming growth factor-β1 (TGFβ1) in the diagnosis of primary liver cancer using a meta-analysis.Methods PubMed,EMBASE,Cochrane Library,CBM,CNKI,Wanfang Data,and VIP were searched for articles on TGFβ1 in the diagnosis of primary liver cancer published up to June 30,2016.The Overview Quality Assessment Questionnaire was used to evaluate the quality of articles screened out.Stata 13.0 software was used for the analysis of diagnostic odds ratio,positive likelihood ratio,and negative likelihood ratio,the summary receiver operating characteristic (SROC) curve was plotted,and publication bias was tested.The confidence level was expressed as 95％ confidence interval (95％ CI).The Q test and I2 test were used for testing heterogeneity,and a subgroup analysis was also performed.Results A total of 16 articles were included,with 1124 patients in liver cancer group and 1443 patients in control group.The sensitivity was 0.68 (95 ％ CI:0.52-0.80) and the specificity was 0.85 (95 ％ CI:0.74-0.92).The diagnostic odds ratio,positive likelihood ratio,and negative likelihood ratio were 11.75 (95 ％ CI:6.18-22.36),4.6 (95％ CI:2.7-7.9),and 0.38 (95％CI:0.26-0.56),respectively.The area under the SROC curve was 0.84 (95％ CI:0.80-0.87).The subgroup analysis showed that compared with immunohistochemistry,ELISA had higher positive likelihood ratio and diagnostic odds ratio and a larger area under the SROC curve,as well as a lower negative likelihood ratio.There was heterogeneity among the articles included,and the main sources of heterogeneity were different underlying liver diseases in patients,different types of diseases in non-primary liver cancer group (including benign control group and normal control group),and difference in experimental design.The Deeks funnel plot showed no significant publication bias.Conclusion TGFβ1 has high sensitivity and specificity in the diagnosis of liver cancer and may become an auxiliary index for the diagnosis of liver cancer.%目的 采用Meta分析方法系统评价TFGβ1在原发性肝癌(以下简称肝癌)诊断中的价值.方法 计算机检索PubMed、EMBASE、Cochrane Library、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库及维普数据库中公开发表的TGFβ1诊断原发性肝癌的文献,检索时间为数据库建库至2016年6月30日.筛选出的文献采用OQAQ量表进行评价质量.通过Stata 13.0软件进行效应量诊断比值比、阳性似然比、阴性似然比等指标合并,并绘制综合受试者工作特征曲线(SROC曲线),进行发表偏倚检验.可信度以95％可信区间(95％CI)表示.异质性检验采用Q检验和,检验,同时进行亚组分析.结果 共纳入16篇文献,合计肝癌组1124例,对照组1443例.敏感度及95％ CI为0.68(0.52 ～0.80),特异度及95％ CI为0.85(0.74 ～0.92),诊断比值比及95％ CI为11.75(6.18 ～22.36);阳性似然比及95％ CI为4.6(2.7 ～7.9),阴性似然比及95％ CI为0.38(0.26 ～0.56),SROC曲线下面积及95％ CI为0.84(0.80 ～0.87).亚组分析所得结果显示,ELISA检测方法的阳性似然比、诊断比值比和SROC曲线下面积均高于免疫组化检测,阴性似然比小于免疫组化检测.纳入的文献存在异质性,主要来源为研究对象的肝病背景不同,非原发性肝癌组的构成不统一(包含良性对照组和正常对照),以及实验设计差异等导致.描绘Deeks漏斗图,提示无明显发表偏倚.结论 TGFβ1在肝癌的诊断中具有较高的灵敏度及特异度,有可能成为肝癌的一种辅助诊断指标.