循环外泌体miRNA 检测对肝细胞癌临床诊断效能的Meta 分析

目的 Meta 分析评价循环外泌体微小核糖核酸（micro RNA, miRNA）对肝细胞癌（hepatocellular carcinoma,HCC）的临床诊断效能。方法 依托PubMed, Embase,Cochrane Library,Web of science, 中国期刊全文数据库（CNKI）、万方数据库、中国生物医学文献检索数据库（CBM）和维普咨讯中文期刊服务平台（VIP）检索并筛选从建库至2021年1 月21 日收录的循环外泌体miRNA 应用于HCC 临床诊断的相关文献,采用QUADAS-2（quality assessment ofdiagnostic accuracy studies）对纳入文献质量进行评价,应用Meta-Disc1.4 软件进行分析,计算合并敏感度、合并特异度、合并阳/ 阴性似然比和合并诊断比值比（diagnostic odds ratio, DOR）以及汇总受试者工作曲线（SROC）下面积,以评估诊断的准确性,进而绘制 Fagan’s 列线图进行临床效果评价。结果 按纳入、排除标准筛选获得10 篇文献,共计12 项研究,包括775 例HCC 患者和957 例非HCC 人群;依据各研究间存在由非阈值效应引起的异质性,采用随机效应模型合并效应量,循环外泌体miRNA 诊断HCC 的合并灵敏度、特异度、阳性似然比和阴性似然比分别为0.892,0.884,7.019 和0.122,以及合并DOR=63.695 和SROC 曲线下面积（AUC）为0.950 7（Q=0.891 4）。结论 循环外泌体miRNA 可作为一种潜在的新的生物标志物应用于HCC 临床诊断。

Meta-Analysis of the Diagnostic Value of Circulating Exosomes miRNA Detection for Hepatocellular Carcinoma

Objective To evaluate the clinical diagnostic efficacy of circulating exosomal miRNA in hepatocellular carcinoma (HCC). Methods Based on PubMed, Embase, Cochrane Libarary, Web of science, CNKI, WanFang, CBM and VIP database platforms, the relevant literatures on the application of circulating exosomal miRNA in the clinical diagnosis of HCC from the establishment of the database to January 21, 2021 were searched and screened. The quality of the included literatures was evaluated by QUADAS-2, and analyzed by Meta-Disc1.4 software to calculate the combined sensitivity,combined specificity, combined positive / negative likelihood ratio and combined diagnostic odds ratio (DOR),and summarize the area under the subject working curve (SROC) to evaluate the accuracy of diagnosis, and then draw Fagan’s nomogram for clinical effect evaluation. Results According to the inclusion and exclusion criteria, 10 literatures were obtained, including 12 studies, including 775 HCC patients and 957 non HCC people. According to the heterogeneity caused by non threshold effect among studies, the effect quantity was combined by random effect model. The combined sensitivity, specificity, positive likelihood ratio, positive likelihood ratio were 0.892, 0.884, 7.019 and 0.122, respectively. The combined DOR = 63.695 and the area under SROC curve was 0.950 7, Q = 0.891 4. Conclusion Circulating secrete miRNA can be used as a potential new biomarker in the clinical diagnosis of HCC.