Diagnostic accuracy of point shear wave elastography and transient elastography for staging hepatic fibrosis in patients with non-alcoholic fatty liver disease: a meta-analysis
Diagnostic accuracy of point shear wave elastography and transient elastography for staging hepatic fibrosis in patients with non-alcoholic fatty liver disease: a meta-analysis
复制标题
DOI：
10.1136/bmjopen-2018-021787
复制
发表时间：
2018-08-01
期刊：
影响因子：
2.9
通讯作者：
Ran, Haitao
中科院分区：
文献类型：
--
作者：
Jiang, Weixi;Huang, Sirun;Ran, Haitao
目的通过检索PubMed、Embase、Web of Science和中国国家知识基础设施数据库中截至2017年12月20日的非酒精性脂肪性肝病患者肝纤维化分期的相关记录，评价点剪切波弹性成像和瞬时弹性成像对非酒精性脂肪性肝病患者肝纤维化分期的准确性。建立二元混合效应模型，将PSWE和TE的敏感性、特异性、阳性似然比、阴性似然比和受试者工作特征曲线(AUC)下面积结合起来。对非酒精性脂肪肝(NAFLD)患者在肝活检前进行PSWE和TE肝脏硬度测定，根据以下标准入选：2×2列联表可通过报告病例数计算；敏感性和特异性根据以下标准排除：有其他肝损害病史，如慢性丙型肝炎、并发活动性乙肝感染、自身免疫性肝炎、可疑药物使用和酗酒。PSWE和TE的AUC分别为0.86(95%CI 0.83~0.89)、0.94(95%CI 0.91~0.95)和0.95(95%CI 0.93~0.97)，TE分别为0.85(95%CI 0.82~0.88)、0.92(95%CI 0.89~0.94)和0.94(95%CI 0.93~0.97)。与pSWE相比，使用M探头的TE测量失败的比例是普通TE的10倍以上。结论PSWE和TE为NAFLD提供了精确的无创性肝纤维化分期，是一种有前途的技术，特别是对于晚期纤维化和肝硬变。
Objective This study aimed to assess the accuracy of staging liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) usingpoint shear wave elastography (pSWE) and transient elastography (TE).Setting Relevant records on NAFLD were retrieved from PubMed, Embase, Web of Science and the China National Knowledge Infrastructure databases up to 20 December 2017. A bivariate mixed-effects model was conducted to combine sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and area under the summary receiver operating characteristic curve (AUC) between pSWE and TE. A sensitivity analysis was implemented to explore the source of heterogeneity.Participants Patients with NAFLD who had a liver stiffness measurement using pSWE and TE before liver biopsy were enrolled according to the following criteria: 2x2contingency tables can be calculated via the reported number of cases; sensitivity and specificity were excluded according to the following criteria: history of other hepatic damage, such as chronic hepatitis C, concurrent active hepatitis B infection, autoimmune hepatitis, suspicious drug usage and alcohol abuse.Results Nine pSWE studies comprising a total of 982 patients and 11 TE studies comprising a total of 1753 patients were included. For detection of significant fibrosis, advanced fibrosis and cirrhosis, the summary AUC was 0.86 (95% CI 0.83 to 0.89), 0.94 (95% CI 0.91 to 0.95) and 0.95 (95% CI 0.93 to 0.97) for pSWE, and the summary AUC was 0.85 (95% CI 0.82 to 0.88), 0.92 (95% CI 0.89 to 0.94) and 0.94 (95% CI 0.93 to 0.97) for TE, respectively. The proportion of failure measurement was over tenfold as common with TE using an M probe compared with pSWE.Conclusion pSWE and TE, providing precise non-invasive staging of liver fibrosis in NAFLD, are promising techniques, particularly for advanced fibrosis and cirrhosis.