醋酸染色肉眼观察法对中国女性宫颈上皮内瘤样病变筛查效果的Meta分析

目的 通过诊断试验Meta分析,评价在中国女性中使用醋酸染色肉眼观察法(VIA)对宫颈癌及其癌前病变进行初筛的效果.方法 以“醋酸”、“宫颈上皮内瘤样病变”、“宫颈癌”、“visual inspection with acetic acid”、“CIN”和“cervical cancer”作为检索词分别检索万方数据库、中国知网(CNKI)、维普中文科技期刊全文数据库、Pubmed、Cochrane图书馆等,并对所获文献中的参考文献进行二次检索,收集关于在中国妇女中开展VIA初筛宫颈癌及其癌前病变的相关文献,共检索到相关文献40篇.采用SAS 8.02进行双变量随机效应模型进行统计学分析.结果 最终有22篇文献符合纳入标准,包括中文文献19篇,英文文献3篇,纳入研究对象共计23 330名.入选文献年限跨度为2004-2010年,研究对象年龄范围为15～ 81岁.按不同筛查病变阈值分层后可见,VIA初筛轻度及以上宫颈上皮内瘤样病变(CIN1+)的加权诊断比值比(DOR) [4.11 (95％ CI:3.20 ～5.04)]与中度及以上病变(CIN2+)[4.45(95％CI:3.73 ～5.15)]相近.CIN1+和CIN2+在40岁及以下中国女性中VIA的DOR[CIN1+为4.22(95％ CI:3.29～5.16);CIN2+为4.53(95％CI:3.46 ～5.47)]也均与40岁以上女性相近[CIN1+为3.66(95％ CI:2.27 ～5.37);CIN2+为4.26(95％ CI:3.32～5.26)].对于CIN2+,县级医院筛查效果与市级及以上医院无区别,DOR分别为4.62(95％CI:3.13 ～5.93)和4.48(95％CI:3.71 ～5.16).结论 VIA对于各级病变和各年龄段人群筛查效果较为一致,县级医院的医生经培训后能够达到与市级医院一样的水平.

Diagnosis of cervical intraepithelial neoplasia by visual inspection with acetic acid among Chinese women: a meta-analysis

Objective To evaluate the performance of visual inspection with acetic acid (VIA) in preliminary screening of cervical cancer and its precancerous lesions among Chinese women by meta-analysis of diagnosis.Methods Pubmed,Cochrane,Wanfang,CNKI and Weipu databases were employed to search for citations using the MeSH terms as "acetic acid"," cervical intraepithelial neoplasia",and "cervical cancer" both in Chinese and English.Additional relevant references cited in retrieval articles were also searched.40 pieces of research paper related with screening of cervical cancer and precancerous lesions of cervical cancer in Chinese women by VIA were collected.Bivariate random effects model was adopted using SAS 8.02.Results Twenty-two studies including 23 330 cases were finally selected in the analysis,among which 19 studies were reported in Chinese and the other 3 in English.These studies were reported from 2004to 2010 and the age-range of subjects was between 15 and 81 years old.Stratified analysis of diagnosis threshold showed that the pooled diagnostic odds ratio(DOR) of VIA for CIN1 + (4.11,95％ CI:3.20 -5.04) was similar to that for C IN2 + (4.45,95 ％ CI: 3.73 -5.15 ).Either CIN1 + or CIN2 +,the DOR in younger women( ≤40 year) (4.22,95％ CI:3.29 - 5.16 ; 4.53,95％ CI:3.46 - 5.47 ) was also similar to it in older women ( ＞ 40 year) ( 3.66,95％ CI: 2.27 - 5.37 ; 4.26,95％ CI: 3.32 - 5.26 ).There was no difference in the screening performance between county-level doctors (DOR =4.62,95 ％ CI: 3.13 -5.93 )and municipal-level doctors ( DOR =4.48,95％ CI: 3.71 - 5.16 ).Conclusion The screening performances of VIA were relatively consistent among different lesion grades and aging groups of Chinese women.After professional training,there was no difference in performance between county-level hospitals and municipal-level hospitals.