Liver Stiffness on Magnetic Resonance Elastography and the MEFIB Index and Liver-Related Outcomes in Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Individual Participants.
Liver Stiffness on Magnetic Resonance Elastography and the MEFIB Index and Liver-Related Outcomes in Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Individual Participants.
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磁共振弹性图以及MEFIB指数和与肝脏相关的结果的肝僵硬在非酒精性脂肪肝病中的结局：对个别参与者的系统评价和荟萃分析。
DOI：
10.1053/j.gastro.2022.06.073
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发表时间：
2022-10
期刊：
影响因子：
29.4
通讯作者：
中科院分区：
文献类型：
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作者：
磁共振弹性成像（MRE）是肝纤维化的准确生物标志物，然而，有限的数据表征其与临床结局的相关性。我们对非酒精性脂肪性肝病（NAFLD）患者进行了个体参与者数据汇总荟萃分析（IPDMA），以评估MRE的肝硬度（LS）与肝脏相关结局之间的相关性。一项系统性检索确定了6个接受基线MRE的NAFLD成人队列，并对肝功能失代偿、肝细胞癌（HCC）和死亡进行了随访。采用考克斯回归和逻辑回归评估LS对MRE和肝脏相关结局之间的相关性，包括定义为需要治疗的静脉曲张、腹水和肝性脑病的复合主要结局。该IPDMA包括2018例患者（53%为女性），平均（±标准差）年龄为57.8（±14）岁，基线MRE分别为4.15（±2.19）kPa。在1707例有可用纵向数据的患者中，中位（IQR）随访时间为3（4.2）年，与MRE < 5 kPa的患者相比，MRE在5-8 kPa之间的主要结局风险比（HR）为11.0（95%CI：7.03-17.1，P <.001），≥ 8 kPa的主要结局风险比（HR）为15.9（95%CI：9.32-27.2，P < .001）。MEFIB指数（当MRE ≥ 3.3kPa且FIB-4 ≥ 1.6时定义为阳性）与主要结局具有强相关性，HR为20.6（95% CI：10.4-40.8，P < .001），MEFIB阴性对主要结局具有较高的阴性预测值，5年时为99.1%。MRE<5 kPa、5-8 kPa和MRE≥8 kPa的3年HCC发生率分别为0.35%、5.25%和5.66%。通过MRE评估的肝硬度与肝脏相关事件相关，并且MRE和FIB-4的组合对肝功能失代偿具有极好的阴性预测值。这些数据对临床实践具有重要意义。
Magnetic resonance elastography (MRE) is an accurate biomarker of liver fibrosis, however, limited data characterize its association with clinical outcomes. We conducted individual participant data pooled meta-analysis (IPDMA) on patients with nonalcoholic fatty liver disease (NAFLD) to evaluate the association between liver stiffness (LS) on MRE and liver-related outcomes. A systematic search identified 6 cohorts of adults with NAFLD who underwent a baseline MRE and were followed for hepatic decompensation, hepatocellular carcinoma (HCC) and death. Cox- and logistic-regression were used to assess the association between LS on MRE and liver-related outcomes including a composite primary outcome defined as varices needing treatment, ascites and hepatic encephalopathy. This IPDMA included 2018 patients (53% women) with a mean (± standard deviation) age of 57.8 (±14) years and MRE at baseline of 4.15 (±2.19) kPa, respectively. Among 1707 patients with available longitudinal data with a median (IQR) of 3 (4.2) years of follow-up, the hazard ratio (HR) for the primary outcome for MRE between 5–8 kPa was 11.0 (95%CI: 7.03–17.1, P < .001) and for ≥ 8 kPa was 15.9 (95%CI:9.32–27.2, P < .001), compared to those with MRE < 5 kPa. The MEFIB index (defined as positive when MRE ≥ 3.3kPa and FIB-4 ≥ 1.6) had a robust association with the primary outcome with a HR of 20.6 (95% CI: 10.4–40.8, P < .001) and a negative MEFIB had a high negative predictive value for the primary outcome, 99.1% at 5 years. The 3-year risk of incident HCC was 0.35% for MRE<5 kPa, 5.25% for 5–8 kPa, and 5.66% for MRE≥8 kPa, respectively. Liver stiffness assessed by MRE is associated with liver-related events and the combination of MRE and FIB-4 has excellent negative predictive value for hepatic decompensation. These data have important implications for clinical practice.
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DOI：
10.1056/nejmoa2029349
发表时间：
2021-10-21
期刊：
The New England journal of medicine
影响因子：
--
作者：
Sanyal AJ;Van Natta ML;Clark J;Neuschwander-Tetri BA;Diehl A;Dasarathy S;Loomba R;Chalasani N;Kowdley K;Hameed B;Wilson LA;Yates KP;Belt P;Lazo M;Kleiner DE;Behling C;Tonascia J;NASH Clinical Research Network (CRN)
通讯作者：
NASH Clinical Research Network (CRN)
影响因子：
29.4
作者：
Angulo P;Kleiner DE;Dam-Larsen S;Adams LA;Bjornsson ES;Charatcharoenwitthaya P;Mills PR;Keach JC;Lafferty HD;Stahler A;Haflidadottir S;Bendtsen F
通讯作者：
Bendtsen F
影响因子：
7.6
作者：
Higuchi, Mayu;Tamaki, Nobuharu;Kurosaki, Masayuki;Inada, Kento;Kirino, Sakura;Yamashita, Koji;Hayakawa, Yuka;Osawa, Leona;Takaura, Kenta;Maeyashiki, Chiaki;Kaneko, Shun;Yasui, Yutaka;Takahashi, Yuka;Tsuchiya, Kaoru;Nakanishi, Hiroyuki;Itakura, Jun;Loomba, Rohit;Enomoto, Nobuyuki;Izumi, Namiki
通讯作者：
Izumi, Namiki
影响因子：
29.4
作者：
Loomba R;Lim JK;Patton H;El-Serag HB
通讯作者：
El-Serag HB
影响因子：
13.5
作者：
Sanyal, Arun J.;Harrison, Stephen A.;Goodman, Zachary
通讯作者：
Goodman, Zachary