CEA和CYFRA 21-1测定鉴别胸腔积液良恶性的Meta分析

目的 用Meta分析方法系统评价近10年来癌胚抗原(CEA)和细胞角蛋白19片段抗原21-1(CYFRA 21-1)在鉴别良恶性胸腔积液中的价值,并进一步比较两者在诊断效能上的差异.方法 收集1996年1月-2007年1月间国内外公开发表的关于CEA和CYFRA 21-1鉴别良恶性胸腔积液的文献,对纳入文献进行方法学质量评估后,运用Q检验评价数据的异质性,合并其灵敏度和特异性,用两者综合受试者工作特征(SROC)曲线下面积(AUC)评价和比较(Z检验)CEA和CYFRA 21-1鉴别良恶性胸腔积液的效能.结果 共有19篇文献纳入,研究对象3228例.CEA汇总的灵敏度和特异性[95%可信区间(CI)]为45.9%(43.2%～48.5%)和97.0%(96.0%～97.8%), CYFRA 21-1汇总的灵敏度和特异性(95%CI)为47.3%(44.0%～50.6%)和91.8%(89.5%～93.7%),其结果均存在明显的异质性(P＜0.05).CEA和CYFRA 21-1的AUC分别为0.7691和0.8213,Z检验比较两者AUC差异无统计学意义(Z=0.45,P＞0.05).结论 CEA和CYFRA 21-1在诊断良恶性胸腔积液时均具有较好的准确性.

Clinical value of CEA and CYFRA21-1 for the differentiation of benign and malignant pleural effusion by Meta analysis

Objective Pleural effusion is a common clinical complication caused by many benign or malignant diseases. Many published papers presented that tumor-marker assays, such as carcinoembryonic antigen (CEA) and cytokeratin 19 fragment antigen 21-1 (CYFRA21-1), played a vital role on the benign and malignant differentiation. This study aimed to reviewe currently available published papers to evaluate the clinical value of those two markers for the differentiation of benign and malignant pleural effusion. Methods All published data of pleural effusion CEA and CYFRA21-1 for the differentiation studies from year 1996 to 2007 were reviewed. By methodological qualities and Q test, 19 papers were selected into this study. The overall diagnostic sensitivity, specificity, and area under curve (AUC) from receiver operating characteristic (ROC) curve were adopted to compare the value of pleural effusion CEA and CYFRA21-1 for benign and malignant differentiation used Z test. Results There were 3228 subjects included in this Meta-analysis. The sensitivity and specificity [95% confidence interval (CI)] of CEA were 45.9%(43.2%～48.5%) and 97.0%(96.0%～97.8%), and of CYFRA21-1,47.3%(44.0%～50.6%) and 91.8%(89.5%～93.7%). AUC of CEA and CYFRA21-1 were 0.7691 and 0.8213 respectively (Z=0.45,P＞0.05). Conclusion Both CEA and CYFRA21-1 are useful for the differentiation of benign and malignant pleural effusion.