羟基喜树碱与吡柔比星膀胱灌注预防膀胱肿瘤复发的有效性和安全性比较的Meta分析以及荧光原位杂交技术在上尿路尿路上皮癌诊断

发布时间：2018-07-29 09:30

【摘要】：目的：比较羟基喜树碱与吡柔比星膀胱灌注预防膀胱肿瘤复发的有效性和安全性。方法：计算机检索1988-01~2013-04期间PubMed,EMBASE,Cochrane图书馆，CNKI，万方数据库。纳入羟基喜树碱与吡柔比星膀胱灌注预防膀胱肿瘤复发有效性和安全性的研究。对纳入研究根据Cochrane手册进行质量评价后采用Stata12软件进行Meta分析。结果：共纳入13个研究，包括1122例患者，其中羟基喜树碱组共530例，吡柔比星组共592例。对13篇研究进行Meta分析。结果显示，羟基喜树碱膀胱灌注预防膀胱肿瘤复发的疗效低于吡柔比星,RR=1.446，95%CI(1.152，1.815)(P0.01)。但是羟基喜树碱膀胱灌注时血尿的发生率低于吡柔比星, RR=0.453，95%CI(0.252，0.816)(P0.01)。结论：患者能耐受不良反应的情况下，与羟基喜树碱相比吡柔比星膀胱灌注预防膀胱肿瘤复发效果更好。但由于所纳入研究的质量不高，上述结论尚需高质量、大样本的随机盲法对照实验加以证实。目的:评价荧光原位杂交技术在上尿路尿路上皮癌诊断中的应用价值。方法:计算机检索PubMed,Cochrane图书馆、中国知网和万方数据库，收集荧光原位杂交技术诊断上尿路尿路上皮癌的研究文献，按QUADAS标准评价文献的质量，采用MetaDisc1.4软件进行Meta分析，计算合并效应量，并绘制受试者工作特征曲线（SROC曲线）和计算曲线下面积，以评价荧光原位杂交技术诊断上尿路尿路上皮癌的价值。结果:共纳入11篇文献，涉及了902个病例。异质性检验显示无阈值效应，但存在其他原因导致的异质性。Meta分析结果合并敏感度、合并特异度、合并阳性似然比、合并阴性似然比、合并诊断性试验比值比分别为82%[95%CI(0.78，，0.86）)、95%[95%CI（0.93，0.96）]、10.37[95%CI（5.06，21.26）]、0.21[95%C（I0.14，0.30）]、59.26[95%C（I22.97，152.87）]。合并ROC曲线下面积（AUC）为0.9368。结论: FISH为上尿路尿路上皮癌的术前定性诊断提供了无创、特异性高且敏感性高的检查手段。
[Abstract]:Objective: to compare the efficacy and safety of hydroxycamptothecin and pirarubicin in preventing bladder tumor recurrence. Methods: a computer-based search was carried out on the PubMedus EMBASE Cochrane Library, CNKI, Wanfang database, from 1988-01 to 2013-04. To study the efficacy and safety of intravesical instillation of hydroxycamptothecin and pirarubicin in the prevention of bladder cancer recurrence. According to the Cochrane manual to evaluate the quality of the inclusion study, Stata12 software was used for Meta analysis. Results: a total of 13 studies were conducted, including 1122 patients, including 530 cases in hydroxy camptothecin group and 592 cases in pirarubicin group. 13 studies were analyzed by Meta. The results showed that the efficacy of hydroxy camptothecin instillation in preventing bladder tumor recurrence was lower than that of pirarubicin 1.446c95 CI (1.152 卤1.815) (P0.01). However, the incidence of hematuria during bladder instillation of hydroxycamptothecin was lower than that of pirarubicin, and RRX 0.45395 CI (0.252 卤0.816) (P0.01). Conclusion: compared with hydroxycamptothecin, the effect of intravesical instillation of pirarubicin on preventing bladder tumor recurrence is better than that of hydroxycamptothecin. However, because the quality of the study is not high, these conclusions need to be confirmed by a large sample of randomized blind controlled trials. Objective: to evaluate the value of fluorescence in situ hybridization in the diagnosis of upper urinary epithelial carcinoma. Methods: the online database of PubMedus Cochrane, China Zhiwang and Wanfang were searched, and the literature on the diagnosis of upper urinary tract epithelial carcinoma by fluorescence in situ hybridization was collected. The quality of the literature was evaluated according to QUADAS standard, and the Meta analysis was carried out by MetaDisc1.4 software. To evaluate the value of fluorescence in situ hybridization (fish) in the diagnosis of upper urinary tract epithelial carcinoma, the combined effect was calculated, and the operating characteristic curve (SROC curve) and the area under the curve were drawn. Results: totally 11 articles were included, involving 902 cases. Heterogeneity test showed no threshold effect, but there were other reasons for heterogeneity. Meta-analysis showed that the sensitivity, specificity, positive likelihood ratio and combined negative likelihood ratio were 82% [95%CI (0.780.86) 95% [95%CI (0.930.96)] 10.37 [95%CI (5.0621.26)] 0.21 [95C (I0.140.30)] 59.26 [95C (I22.97152.87)]. The area (AUC) under the combined ROC curve was 0.9368. Conclusion: FISH is a noninvasive, highly specific and sensitive method for the preoperative qualitative diagnosis of upper urinary epithelial carcinoma.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14

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