血清AFP-L3和GP-73联合检测对原发性肝癌诊断的Meta分析
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摘要
目的通过Meta分析及系统评价评估甲胎蛋白异质体L3(AFP-L3)和高尔基体糖蛋白73(GP73)联合检测诊断原发性肝癌的诊断价值。方法通过计算机检索和手工查询获得AFP-L3和GP73联合检测诊断原发性肝癌的文献,通过纳入和排除标准筛选文献并提取数据。采用Meta Disc1.4软件检验研究间异质性,并对诊断准确度指标进行Meta分析,绘制综合受试者工作特性曲线(SROC)。结果 AFP-L3和GP73联合检测诊断原发性肝癌的汇总灵敏度、特异度和诊断优势比分别为0.86(95%CI:0.82～0.89),0.95(95%CI:0.93～0.96)和155.20(95%CI:57.47～419.1)。SROC曲线下面积(AUC)为0.981 2,Q指数为0.939 4。结论 AFP-L3和GP73联合检测在原发性肝癌的诊断中具有较高的灵敏度及准确性,可作为诊断原发性肝癌的重要指标。
Objective To investigate the clinical value of combined detection of serum Golgi protein73(GP73) and AFP-L3 in the diagnosis of primary liver cancer.Methods Comprehensive electronic and manual searches were performed to retrieve relevant studies on the combined detection of serum AFP-L3 and GP-73 in diagnosis of primary liver cancer.After screening of the studies according to inclusion criteria and extraction of the data,meta-analysis was performed in Meta-disc 1.4 and Stata 14.0.Results Six studies that met the inclusion criteria were selected from the total 168 references with potential relevance.The threshold effect was found in the combined detection of serum AFP-L3 and GP-73 in diagnosis of primary liver cancer.However,heterogeneity was found in this meta-analysis.The pooled sensitivity and specificity of AFP-L3 combined with GP-73 was 0.86(95% CI:0.82～0.89),0.95(95% CI:0.93～0.96) and 155.20(95% CI:57.47～419.1),respectively.The area under summary receiver operating characteristics curve was 0.981 2,and the Q index was 0.939 4.Conclusion AFP-L3 combined with GP73 can significantly improve the diagnostic sensitivity and specificity to a high level,and can improve the diagnosis rate of Primary liver cancer.
Objective To investigate the clinical value of combined detection of serum Golgi protein73(GP73) and AFP-L3 in the diagnosis of primary liver cancer.Methods Comprehensive electronic and manual searches were performed to retrieve relevant studies on the combined detection of serum AFP-L3 and GP-73 in diagnosis of primary liver cancer.After screening of the studies according to inclusion criteria and extraction of the data,meta-analysis was performed in Meta-disc 1.4 and Stata 14.0.Results Six studies that met the inclusion criteria were selected from the total 168 references with potential relevance.The threshold effect was found in the combined detection of serum AFP-L3 and GP-73 in diagnosis of primary liver cancer.However,heterogeneity was found in this meta-analysis.The pooled sensitivity and specificity of AFP-L3 combined with GP-73 was 0.86(95% CI:0.82～0.89),0.95(95% CI:0.93～0.96) and 155.20(95% CI:57.47～419.1),respectively.The area under summary receiver operating characteristics curve was 0.981 2,and the Q index was 0.939 4.Conclusion AFP-L3 combined with GP73 can significantly improve the diagnostic sensitivity and specificity to a high level,and can improve the diagnosis rate of Primary liver cancer.
引文
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[7] 徐万菊,韩玉刚,张芊,等.甲胎蛋白异质体与高尔基体蛋白73在甲胎蛋白低浓度肝细胞癌诊断中的意义[J].中华检验医学杂志,2012,35(2):174-176.XU Wanju,HAN Yugang,ZHANG Qian,et al.Significance of alpha-fetoprotein heterogene and Golgi protein 73 in the diagnosis of low-level hepatocellular carcinoma of alpha fetoprotein[J].Chinese Journal of Laboratory Medicine,2012,35(2):174-176.
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[9] 罗文明,陈琳,曹亚丽,等.血清GP73及AFP-L3检测在原发性肝癌诊断中的意义[J].临床和实验医学杂志,2013,12(13):1005-1006,1009.LUO Wenming,CHEN Lin,CAO Yali,et al.Diagnostic significane of combined application of serum GP73 and AFP-L3 in patients with PHC[J].Journal of Clinical and Experimental Medicine,2013,12(13):1005-1006,1009.
[10] 徐伟红,姚怡婷,曹华,等.血清GP73,AFP-L3,AFP及AFU检测在原发性肝癌诊断中的应用评价[J].中华检验医学杂志,2016,39(4):262-266.XU Weihong,YAO Yiting,CAO Hua,et al.Assessment of serum GP73,AFP-L3,AFP and AFU detecting in the diagnosis of hepatocellular carcinoma[J].Chinese Journal of Laboratory Medicine,2016,39(4):262-266.
[11] 沈莉英,熊彩萍,高艳.高尔基体蛋白73与甲胎蛋白异质体在原发性肝癌诊断中的临床应用[J].实用医技杂志,2014,21(12):1321-1323.SHEN Liying,XIONG Caiping,GAO Yan.Clinical application of Golgi protein 73 and alpha-fetoprotein heterogene in the diagnosis of primary liver cancer[J].Journal of Practical Medical Techniques,2014,21(12):1321-1323.
[12] 施明明,黄桢翔,杨月,等.高尔基体糖蛋白73联合甲胎蛋白L3诊断原发性肝癌的荟萃分析[J].中华肝脏病杂志,2015,23(3):189-193.SHI Mingming,HUANG Zhenxiang,YANG Yue,et al.Diagnostic value of serum Golgi protein-73(GP73) combined with AFP-L3% in hepatocellular carcinoma:a meta-analysis[J].Chinese Journal of Hepatology,2015,23(3):189-193.
[13] WHITING P F,RUTJES A W,WESTWOOD M E,et al.QUADAS-2:a revised tool for the quality assessment of diagnostic accuracy studies[J].Annals of Internal Medicine,2011,155(8):529-536.
[2] SALGIA R,SINGAL A G.Hepatocellular carcinoma and other liver lesions[J].The Med Clin North Am,2014,98(1):103-118.
[3] ZHU Kai,DAI Zhi,ZHOU Jian.Biomarkers for hepatocellular carcinoma:progression in erly diagnosis,progress,and personalized therapy[J].Biomark Res,2013,1(1):10.
[4] 王婷,张焜和.AFP阴性肝癌的肿瘤标志物诊断的研究进展[J].世界华人消化杂志,2011,19(33):3420-3425.WANG Ting,ZHANG Kunhe.Progress in research of tumor markers for diagnosis of hepatocellular carcinoma in AFP-negative patients[J].World Chinese Journal of Digestion,2011,19(33):3420-3425.
[5] DANIELE B,BENCIVENGA A,MEGNA A S,et al.Alpha-fetoprotein and ultrasonography screening for hepatocellular carcinoma[J].Gastroenterology,2004,127(5 suppl 1):108-112.
[6] 程魏.AFP-L3和GP73联合检测在原发性肝癌诊断及疗效评估中的应用[D].石家庄:河北医科大学,2013.CHENG Wei.Application of AFP-L3 and GP73 combined detection in hepatocellular carcinoma diagnosis and curative effect evaluation[D].Shijiazhuang:Hebei Medical University,2013.
[7] 徐万菊,韩玉刚,张芊,等.甲胎蛋白异质体与高尔基体蛋白73在甲胎蛋白低浓度肝细胞癌诊断中的意义[J].中华检验医学杂志,2012,35(2):174-176.XU Wanju,HAN Yugang,ZHANG Qian,et al.Significance of alpha-fetoprotein heterogene and Golgi protein 73 in the diagnosis of low-level hepatocellular carcinoma of alpha fetoprotein[J].Chinese Journal of Laboratory Medicine,2012,35(2):174-176.
[8] 郭晓红.血清AFP-L3与GP73联合检测对AFP低浓度肝癌的诊断价值[J].国际检验医学杂志,2013,34(18):2379-2380,2382.GUO Xiaohong.Diagnostic value of combined detection of serum AFP-L3 and GP73 in primary liver cancer with low level of AFP[J].International Journal of Laboratory Medicine,2013,34(18):2379-2380,2382.
[9] 罗文明,陈琳,曹亚丽,等.血清GP73及AFP-L3检测在原发性肝癌诊断中的意义[J].临床和实验医学杂志,2013,12(13):1005-1006,1009.LUO Wenming,CHEN Lin,CAO Yali,et al.Diagnostic significane of combined application of serum GP73 and AFP-L3 in patients with PHC[J].Journal of Clinical and Experimental Medicine,2013,12(13):1005-1006,1009.
[10] 徐伟红,姚怡婷,曹华,等.血清GP73,AFP-L3,AFP及AFU检测在原发性肝癌诊断中的应用评价[J].中华检验医学杂志,2016,39(4):262-266.XU Weihong,YAO Yiting,CAO Hua,et al.Assessment of serum GP73,AFP-L3,AFP and AFU detecting in the diagnosis of hepatocellular carcinoma[J].Chinese Journal of Laboratory Medicine,2016,39(4):262-266.
[11] 沈莉英,熊彩萍,高艳.高尔基体蛋白73与甲胎蛋白异质体在原发性肝癌诊断中的临床应用[J].实用医技杂志,2014,21(12):1321-1323.SHEN Liying,XIONG Caiping,GAO Yan.Clinical application of Golgi protein 73 and alpha-fetoprotein heterogene in the diagnosis of primary liver cancer[J].Journal of Practical Medical Techniques,2014,21(12):1321-1323.
[12] 施明明,黄桢翔,杨月,等.高尔基体糖蛋白73联合甲胎蛋白L3诊断原发性肝癌的荟萃分析[J].中华肝脏病杂志,2015,23(3):189-193.SHI Mingming,HUANG Zhenxiang,YANG Yue,et al.Diagnostic value of serum Golgi protein-73(GP73) combined with AFP-L3% in hepatocellular carcinoma:a meta-analysis[J].Chinese Journal of Hepatology,2015,23(3):189-193.
[13] WHITING P F,RUTJES A W,WESTWOOD M E,et al.QUADAS-2:a revised tool for the quality assessment of diagnostic accuracy studies[J].Annals of Internal Medicine,2011,155(8):529-536.