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目的系统评价人类乳头状病毒检测对宫颈癌前病变的诊断价值。方法计算机检索CBM、CNKI、MEDLINE、PubMed、EMbase(均从建库至2010年6月),Cochrane临床对照试验中心注册库(2010年第2期),并手工检索相关杂志和纳入研究的参考文献。由两位评价员按照纳入与排除标准独立选择文献、提取资料和评价质量后,采用MetaDisc1.4软件进行Meta分析,并用RevMan5.0软件绘制森林图和SROC曲线。结果共纳入7个随机对照研究,合计171604例受试者。Meta分析结果显示:与传统的宫颈细胞学检查比较,人类乳头状病毒(HPV)检测能明显提高对宫颈癌前病变诊断的敏感性,其中HPV联合宫颈细胞学筛查诊断宫颈上皮内瘤变2级及以上病变时,与传统的宫颈细胞学检查比较差异有统计学意义(P<0.00001);但HPV检测却明显降低了对其诊断的特异性;只检测HPV,同时检测HPV和宫颈细胞学和先检测HPV。再以细胞学分流的方法诊断宫颈上皮内瘤变,与传统宫颈细胞学检查比较,除了第三种方法诊断宫颈上皮内瘤变1级及以上病变无统计学差异外(P=0.41),其余两种方法与之比较均有明显的统计学差异(P<0.01)。结论现有循证医学证据显示,与传统的宫颈细胞学筛查相比,HPV检测联合宫颈细胞学筛查可以明显提高诊断宫颈上皮内瘤变2级及以上病变的敏感性,但HPV检测并不能提高诊断宫颈癌前病变的特异性;应用HPV检测筛查宫颈癌前病变有待进一步研究。
Objective To evaluate the diagnostic value of human papillomavirus (HPV) in the diagnosis of cervical precancerous lesions. Methods CBM, CNKI, MEDLINE, PubMed, EMbase (both from the database to June 2010) and the Cochrane Central Register of Controlled Cochrane Database (Issue 2, 2010) were searched by computer and hand-searched relevant journals and included references . Meta-analysis was performed by MetaDisc 1.4 software and forest diagram and SROC curve were constructed by RevMan 5.0 software after two reviewers independently selected documents, extracted data and evaluated the quality according to inclusion and exclusion criteria. Results A total of 7 randomized controlled trials were included, totaling 17,1604 subjects. Meta-analysis showed that compared with traditional cervical cytology, HPV testing could significantly improve the sensitivity of cervical precancerous lesions diagnosis. HPV combined with cervical cytology screening for cervical intraepithelial neoplasia 2 Grade and above lesions, compared with the traditional cervical cytology was significantly different (P <0.00001); but HPV testing was significantly reduced the specificity of its diagnosis; only HPV testing, simultaneous detection of HPV and cervical cytology And first test HPV. Cervical intraepithelial neoplasia was diagnosed by cytological shunt method. Compared with traditional cervical cytology, except for the third method of cervical intraepithelial neoplasia grade 1 and above, there was no significant difference (P = 0.41), the rest There was a significant difference between the two methods (P <0.01). Conclusion Evidence based on evidence-based medicine shows that, compared with the traditional screening of cervical cytology, HPV screening combined with cervical cytology screening can significantly improve the sensitivity of detecting grade 2 and above cervical intraepithelial neoplasia, but HPV testing and Can not improve the specificity of diagnosis of cervical precancerous lesions; the application of HPV testing for screening precancerous lesions of the cervix remains to be further studied.