循环miRNA用于乳腺癌早期诊断的meta分析*
Meta analysis of role of circulating miRNA in early diagnosis of breast cancer

目的:评价循环miRNA在乳腺癌早期诊断的作用,为推广循环miRNA在临床的广泛应用提供依据。方法:计算机检索Pubmed、Embase、Medline、中国知网、万方数据库等数据库中2008年1月至2015年5月关于循环miRNA用于乳腺癌早期诊断的临床研究。根据纳入和排除标准,将最终纳入文献归类整理,提取原始有效数据后进行汇总,利用Med-Disc 1.4进行meta分析。结果:共纳入20篇相关临床研究,24个独立的病例对照研究,其中包含乳腺癌患者2 030例,健康对照组1 318例。各研究之间存在显著异质性,采用随机效应模型合并灵敏度、特异度分析。循环miRNA用于早期诊断乳腺癌的合并灵敏度、特异度、阳性似然比、阴性似然比、诊断优势比、曲线下面积(AUC)及其95%CI分别为0.79(0.78～0.81)、0.81(0.88～0.83)、5.06(3.55～7.22)、0.21(0.16～0.27)、29.80(16.74～53.02)、0.907 5。亚组分析表明,以血清为标本检测循环miRNA,诊断优势比较以血浆为标本高54.9%; 联合检测循环miRNA较检测单个miRNA的诊断优势比高42.5%。结论:循环miRNA可以作为肿瘤标志物用于乳腺癌的早期诊断,以血清为标本,联合检测循环miRNA具有更强的检验功效。
Aim: To evaluate the role of circulating miRNA in the early diagnosis of breast cancer, and provide basis for its extensively clinical application.Methods: We got retrieval paper through the Pubmed, Medline, Embase, CNKI et al,and the interval time of retrieval paper was from May 2008 to Jun 2015. According to the inclusive and exclusive rules, papers were selected. Then we extracted original data from the included papers and performed meta-analysis by Med-Disc1.4.Results: Twenty papers with 24 clinical studies, which included 2 030 breast cancer patients and 1 318 health controls. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under the curve were 0.79(95%CI 0.78-0.81),0.81(95%CI 0.880-0.83),5.06(95%CI 3.55-7.22),0.21(95%CI 0.16-0.27),29.80(95%CI 16.74-53.02),0.907 5, respectively. By subgroup analysis, we found that DOR was 54.9% higher than plasma sample when detecting circulating miRNA via serum sample; Single circulating miRNA yielded a 42.5% lower DOR than multiple circulating miRNA did.Conclusion: Circulating miRNA would be a better tumor biomarker for early diagnosis of breast cancer.Serum sample and multiple miRNA detection yield a better diagnostic performance