Diagnostic Value of CK-18, FGF-21, and Related Biomarker Panel in Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis.
Diagnostic Value of CK-18, FGF-21, and Related Biomarker Panel in Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis.
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DOI：
10.1155/2017/9729107
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发表时间：
2017
影响因子：
--
通讯作者：
Yuan F
中科院分区：
文献类型：
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作者：
He L;Deng L;Zhang Q;Guo J;Zhou J;Song W;Yuan F
肝活检仍然是诊断非酒精性脂肪性肝炎（NASH）的金标准，但有局限性。迫切需要开发准确区分NASH和单纯性脂肪变性的非侵入性检测。本荟萃分析的目的是评价血清生物标志物包括细胞角蛋白18（CK-18）、成纤维细胞生长因子21（FGF-21）和联合生物标志物组（CBP）在诊断NAFLD，尤其是NASH中的诊断价值。共有25项研究符合纳入标准。用于诊断NASH的所选血清标志物的合并灵敏度和特异性值如下：CK-18（M30），0.75和0.77; CK-18（M65），0.71和0.77; FGF-21，0.62和0.78;以及CBP，0.92和0.85。CBP显示出更好的准确性，更高的灵敏度和特异性比单独测试。此外，与CK-18或FGF-21测定相比，CBP的AUROC为0.94（95% CI，0.92-0.96），其显示区分NASH与单纯脂肪变性的最显著能力。结果表明，循环CK-18和FGF-21的增加与NASH相关，可用于初步评估，但还不够。重要的是，CBP可能用作NASH的准确诊断工具。进一步的前瞻性设计研究是必要的，以证实我们的研究结果。
Liver biopsy still remains the gold standard for diagnosing nonalcoholic steatohepatitis (NASH), but with limitations. There is an urgent need to develop noninvasive tests that accurately distinguish NASH from simple steatosis. The purpose of this meta-analysis was to evaluate the diagnostic value of serum biomarkers including cytokeratin 18 (CK-18), fibroblast growth factor 21 (FGF-21), and combined biomarker panel (CBP) in the diagnosis of NAFLD, especially NASH. A total of 25 studies met the inclusion criteria. Pooled sensitivity and specificity values for chosen serum markers for diagnosing NASH are as follows: CK-18 (M30), 0.75 and 0.77; CK-18 (M65), 0.71 and 0.77; FGF-21, 0.62 and 0.78; and CBP, 0.92 and 0.85. CBP demonstrated better accuracy with higher sensitivity and specificity than those tested individually. Furthermore, the AUROC of CBP was 0.94 (95% CI, 0.92–0.96), compared to CK-18 or FGF-21 assay, which showed the most significant ability to distinguish NASH from simple steatosis. The results suggest that increased circulating CK-18 and FGF-21 are associated with NASH and may be used for initial assessment, but not enough. Importantly, CBP is potentially used as accurate diagnostic tools for NASH. Further prospective designed studies are warranted to confirm our findings.