高危型HPV E6/E7 mRNA检测对ASCUS患者分流价值的系统评价
Meta analysis for the value of high-risk HPV E6/E7 mRNA test in triage of patients with atypical squamous cells of undetermined significance

目的:系统评价高危型HPV E6/E7 mRNA检测对意义不明确的非典型鳞状细胞(ASCUS)患者分流的诊断价值。方法:通过检索中国生物医学文献数据库、CNKI、万方数据库、PubMed和Web of Science数据库,收集有关HPV E6/E7 mRNA和HPV DNA检测用于ASCUS分流诊断的相关研究,检索时间自建库至2017年12月。由2位研究者根据包容性和排他性标准独立筛选文献、提取数据。结果:共纳入11项研究2 026例患者。Meta分析结果显示,HPV E6/E7 mRNA检测对CINⅡ及以上者的诊断灵敏度(95%CI)为0.84(0.80～0.87),特异度(95%CI)为0.60(0.58～0.63),阳性似然比(95%CI)为2.22(1.76～2.81),阴性似然比(95%CI)为0.30(0.24～0.37),SROC曲线下面积为0.826(Q=0.759)。HPV DNA检测的灵敏度(95%CI)为0.92(0.89～0.95),特异度(95%CI)为0.39(0.37～0.41),阳性似然比(95%CI)为1.54(1.32～1.79),阴性似然比(95%CI)为0.24(0.18～0.33),SROC曲线下面积为0.829(Q=0.761)。结论:HPV E6/E7 mRNA检测对鳞状上皮内高级别病变的诊断优于 HPV DNA,可用于ASCUS患者的分流。
Aim:To systematically evaluate the value of high-risk HPV E6/E7 mRNA testing in triage of patients with atypical squamous cells of undetermined significance(ASCUS).Methods:Studies about diagnostic value of high-risk HPV E6/E7 mRNA test and HPV DNA test in ASCUS patients were retrieved in the databases including Chinese Biomedical Literature,CNKI,Wanfang Database,PubMed and Web of Science databases from construction to December 2017.Two researchers independently screened the literatures according to inclusion and exclusion criteria, extracted data, and assessed the risk of bias.Results:Eleven studies and 2 026 patients were enrolled. The sensitivity(95%CI)of HPV E6/E7 mRNA for high-grade squamous intraepithelial lesion(CINⅡ+)diagnosis was 0.84(0.80-0.87),the specificity(95%CI)was 0.60(0.58-0.63),the positive likelihood ratio(95%CI)was 2.22(1.76-2.81),the negative likelihood ratio(95%CI)was 0.30(0.24-0.37),and the area under the SROC was 0.826(Q=0.759).Those of HPV DNA test was 0.92(0.89-0.95), 0.39(0.37-0.41),1.54(1.32-1.79), 0.24(0.18-0.33),and 0.829(Q =0.761).Conclusion:HPV E6/E7 mRNA test in the diagnosis of high-grade lesions in squamous epithelium is superior to HPV-DNA test,and is helpful for triage of ASCUS