Comparison of Laboratory Tests, Ultrasound, or Magnetic Resonance Elastography to Detect Fibrosis in Patients With Nonalcoholic Fatty Liver Disease: A Meta-Analysis
Comparison of Laboratory Tests, Ultrasound, or Magnetic Resonance Elastography to Detect Fibrosis in Patients With Nonalcoholic Fatty Liver Disease: A Meta-Analysis
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实验室测试、超声或磁共振弹性成像检测非酒精性脂肪肝患者纤维化的比较：荟萃分析
DOI：
10.1002/hep.29302
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发表时间：
2017-11-01
期刊：
影响因子：
13.5
通讯作者：
Wu, Gang
中科院分区：
文献类型：
--
作者：
Xiao, Guangqin;Zhu, Sixian;Wu, Gang
目前已经提出了许多无创诊断肝纤维化的方法。为了确定诊断非酒精性脂肪性肝病(NAFLD)LF的最佳方法，我们对天冬氨酸氨基转移酶/血小板比率指数(APRI)、纤维化-4指数(FIB-4)、Bard评分、NAFLD纤维化评分(NFS)、纤维扫描(FibroScan)、剪切波弹性成像(SWE)和磁共振弹性成像(MRE)在NAFLD中诊断LF的表现进行了系统的回顾和荟萃分析。我们比较了这些非侵入性方法检测显著纤维化(SF)、晚期纤维化(AF)和肝硬变的敏感性、特异性、阳性预测值、阴性预测值和受试者工作特征曲线(AUROC)下的面积。异质性用Meta回归分析。纳入64篇文章，共13,046名非酒精性脂肪肝受试者。在NAFLD患者中，SF、AF和肝硬化的总体平均患病率分别为45.0%、24.0%和9.4%。当APRI阈值为1.0和1.5时，诊断房颤的敏感性和特异性分别为50.0%和84.0%，18.3%和96.1%。当FIB-4阈值为2.67和3.25时，诊断房颤的敏感性和特异性分别为26.6%和96.5%，31.8%和96.0%。Bard评分(阈值2)、NFS值(阈值21.455)、FibroScan M(阈值8.7~9)、SWE和MRE检测房颤的敏感性和特异性分别为0.76和0.61、0.72和0.70、0.87和0.79、0.90和0.93、0.84和0.90。APRI、FIB-4、Bard评分、NFS、FibroScan M探头、XL探头、SWE和MRE诊断房颤的AUROC值分别为0.77、0.84、0.76、0.84、0.88、0.85、0.95和0.96。结论：MRE和SWE对NAFLD患者肝纤维化分期的诊断准确率最高。在4项无创性简易指标中，对房颤的诊断性能最好的可能是纤维蛋白原和纤维蛋白原。
Many noninvasive methods for diagnosing liver fibrosis (LF) have been proposed. To determine the best method for diagnosing LF in nonalcoholic fatty liver disease (NAFLD), we conducted a systemic review and meta-analysis to compare the performance of aspartate aminotransferase to platelets ratio index (APRI), fibrosis-4 index (FIB-4), BARD score, NAFLD fibrosis score (NFS), FibroScan, shear wave elastography (SWE), and magnetic resonance elastography (MRE) for diagnosing LF in NAFLD. We compared the sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUROC) of these noninvasive methods for detecting significant fibrosis (SF), advanced fibrosis (AF), and cirrhosis. Heterogeneity was explored using meta-regression. Sixty-four articles with a total of 13,046 NAFLD subjects were included. The overall mean prevalence of SF, AF, and cirrhosis was 45.0%, 24.0%, and 9.4% in NAFLD patients, respectively. With an APRI threshold of 1.0 and 1.5, the sensitivities and specificities were 50.0% and 84.0% and 18.3% and 96.1%, respectively, for AF. With a FIB-4 threshold of 2.67 and 3.25, the sensitivities and specificities were 26.6% and 96.5% and 31.8% and 96.0%, respectively, for AF. The summary sensitivities and specificities of BARD score (threshold of 2), NFS (threshold of 21.455), FibroScan M (threshold of 8.7-9), SWE, and MRE for detecting AF were 0.76 and 0.61, 0.72 and 0.70, 0.87 and 0.79, 0.90 and 0.93, and 0.84 and 0.90, respectively. The summary AUROC values using APRI, FIB-4, BARD score, NFS, FibroScan M probe, XL probe, SWE, and MRE for diagnosing AF were 0.77, 0.84, 0.76, 0.84, 0.88, 0.85, 0.95, and 0.96, respectively. Conclusion: MRE and SWE may have the highest diagnostic accuracy for staging fibrosis in NAFLD patients. Among the four noninvasive simple indexes, NFS and FIB-4 probably offer the best diagnostic performance for detecting AF.