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目的用M eta分析综合评价低剂量螺旋CT(LDSCT)筛查高危人群早期肺癌的价值。方法搜集1995年1月至2005年6月国内外公开发表的LDSCT筛查高危人群早期肺癌的文献,对符合条件的原始研究进行质量评估、异质性检验和一致性分析。汇总敏感性和特异性,通过汇总受试者工作特征曲线(ROC)和曲线下面积来综合评价LDSCT筛查高危人群早期肺癌的价值,同时对基础扫描和严密随访至少2年后的结果进行比值比(odds ratio,OR)的合并检验,最后进行敏感性分析。结果15篇文献符合纳入标准,由9个独立研究构成,研究对象共8168人,纳入研究存在异质性。按发现结节(B0)、发现结节直径(d)≥5 mm(B5)、发现结节d≥10 mm(B10)3个标准基础扫描的Kappa值分别为0.061、0.134、0.460,汇总敏感性分别为0.686、0.721、0.640,汇总特异性分别为0.708、0.815、0.959。ROC曲线下面积分别为0.778、0.949、0.539,B0与B5的曲线下面积差异无统计学意义(P>0.05),B0与B10及B5与B10的曲线下面积差异有统计学意义(P<0.05)。B5与B10进行基础扫描和严密随访至少2年后结果的合并检验,OR值分别为1.11和1.66。结论纳入文献质量较好。LDSCT筛查高危人群早期肺癌基础扫描中以发现结节d≥5 mm为阳性标准较合理,总的诊断效能较高,严密随访能提高筛查试验的准确性,筛查效果受机会性因素的影响较大,有必要通过设计合理、随访严密的大样本随机对照试验来严格控制机会性因素的影响,进一步证实肺癌筛查试验的有效性。
Objective To evaluate the value of M eta in the comprehensive evaluation of low-dose spiral CT (LDSCT) screening of early-stage lung cancer in high-risk groups. Methods The literatures published in LDSCT screening of early-stage lung cancer in high-risk population from January 1995 to June 2005 were collected and the quality assessment, heterogeneity test and consistency analysis were conducted on the eligible original research. The sensitivities and specificities were summarized and the value of LDSCT screening of early-stage lung cancer in high-risk groups was evaluated by aggregating the receiver operating characteristic curves (ROCs) and the area under the curve, with the ratio of baseline scans and results at least 2 years after close follow-up (Odds ratio, OR) combined test, the final sensitivity analysis. Results Fifteen articles met the inclusion criteria and consisted of 9 independent studies with a total of 8,168 subjects. The inclusion of the study was heterogeneous. According to the finding of nodules (B0), the nodule diameter (d) ≥5 mm (B5) was found. The Kappa values of three standard basal scans of nodules d≥10 mm (B10) were 0.061,0.134 and 0.460, respectively, Sexuality was 0.686,0.721,0.640 respectively, and the summary specificity was 0.708,0.815,0.959 respectively. The areas under the curve of ROC were 0.778, 0.949 and 0.539, respectively. There was no significant difference in the area under the curve between B0 and B5 (P> 0.05). The area under the curve of B0 and B10 and between B5 and B10 were statistically significant (P <0.05 ). B5 and B10 basic scan and close follow-up at least 2 years after the results of the combined test, OR values were 1.11 and 1.66. Conclusion The quality of the included documents is good. LDSCT screening of high-risk groups at early stage of lung cancer based on the scan to find nodules d ≥ 5 mm positive for the more reasonable, the overall diagnostic efficacy is higher, close follow-up can improve the accuracy of screening tests, screening results by opportunistic factors It is necessary to strictly control the influence of the opportunistic factors through a well-designed, closely followed large sample randomized controlled trial to further confirm the effectiveness of the screening test for lung cancer.