HPV mRNA、DNA检测对宫颈细胞学ASCUS分流诊断价值的Meta分析  

The value of HPV E6/E7 mRNA test and HPV DNA test in triage of patients with atypical squamous cells:a systematic review and Meta-analysis

作　　者：陆璐 余慧萍[2] 成建[3] LU Lu;YU Hui-ping;CHENG Jian(Department of Biochemistry,Jiangsu Health Vocational College,Nanjing 211800,China;Department of Pathology,Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University;Department of Prenatal Diagnosis,the Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University)

机构地区：[1]江苏卫生健康职业学院生化教研室,211800 [2]南京大学医学院附属鼓楼医院病理科 [3]南京医科大学附属妇产医院产前诊断中心

出　　处：《天津医药》2020年第12期1223-1229,共7页Tianjin Medical Journal

基　　金：江苏卫生健康职业学院2019年度院级重点项目(JKB201914)。

摘　　要：目的系统评价人乳头瘤病毒(HPV)E6/E7 mRNA和HPV DNA检测在宫颈细胞学检查结果为未明确诊断意义的非典型鳞状上皮细胞(ASCUS)人群中的分流诊断价值。方法检索MEDLINE、EMbase、Cochrane Library、Web of Science、万方数据库、维普数据库和中国知网(CNKI),搜集有关HPV E6/E7 mRNA和HPV DNA检测对ASCUS人群分流诊断的研究,检索时限为2010年1月1日—2019年12月31日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Meta-Disc 1.4软件及Stata 12.1进行Meta分析。结果共纳入15项研究包括ASCUS患者4 019例。HPV E6/E7 mRNA检测诊断宫颈上皮内瘤变Ⅱ级及以上(CINⅡ+)病变的合并敏感度、特异度、阳性似然比、阴性似然比和诊断比值比分别为0.85(95%CI:0.82~0.87)、0.61(95%CI:0.59~0.63)、2.40(95%CI:1.98~2.92)、0.28(95%CI:0.23~0.33)、9.21(95%CI:6.72~12.62);HPV DNA检测分别为0.91(95%CI:0.89~0.93)、0.43(95%CI:0.41~0.45)、1.59(95%CI:1.38~1.83)、0.24(95%CI:0.16~0.35)和7.12(95%CI:4.51~11.26)。2种检测方法的线性模型拟合受试者工作特征(SROC)曲线下面积分别为0.847和0.760。结论 HPV E6/E7 mRNA检测对ASCUS人群的分流诊断价值优于HPV DNA检测,其在ASCUS人群检出CINⅡ+的宫颈病变表现出较高的特异性。Objective To evaluate and compare the diagnostic value of HPV E6/E7 mRNA test and HPV DNA test in classifying population of atypical squamous cells of undetermined significance(ASCUS)by systematic review and Metaanalysis.Methods MEDLINE,EMbase,Cochrane Library,WanFang,Web of Science,VIP and CNKI database were electronically searched,and studies on HPV E6/E7 mRNA test and HPV DNA test in classifying patients with ASCUS,and data were collected from January 1,2010 to December 31,2019.Literatures were independently screened by two reviewers.After extracting data and evaluating the risk of bias of included studies,Meta-Disc1.4 software and Stata12.1 were used for meta-analysis.Results A total of 15 studies including 4019 ASCUS patients were included.The pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio of HPV E6/E7 mRNA test were 0.85(95%CI:0.82-0.87),0.61(95%CI:0.59-0.63),2.40(95%CI:1.98-2.92),0.28(95%CI:0.23-0.33)and 9.21(95%CI:6.72-12.62),respectively.Those of HPV DNA test were 0.91(95%CI:0.89-0.93),0.43(95%CI:0.41-0.45),1.59(95%CI:1.38-1.83),0.24(95%CI:0.16-0.35)and 7.12(95%CI:4.51-11.26),respectively.The areas under the curve(AUC)of HPV E6/E7 mRNA test and HPV DNA test for detecting CINⅡ+were 0.847 and 0.760 respectively.Conclusion Compared with HPV DNA test,HPV E6/E7mRNA test has a higher clinical value in classifying patients with ASCUS,and it shows a high specificity in cervical lesions with CINⅡ+in the ASCUS population.

关 键 词：宫颈肿瘤 人乳头瘤病毒 META分析 HPV DNA检测 HPV E6/E7 mRNA检测 非典型鳞状上皮细胞 

分 类 号：R711.74[医药卫生—妇产科学]