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瞬时弹性成像技术对自身免疫性肝病肝纤维化分期诊断价值的Meta分析

杨志然 王林恒 李园 刘福生 王雨 王建芳 陈润花

引用本文:
Citation:

瞬时弹性成像技术对自身免疫性肝病肝纤维化分期诊断价值的Meta分析

DOI: 10.3969/j.issn.1001-5256.2022.01.015
利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明:杨志然、陈润花负责研究的思路或设计;王林恒、王雨负责研究数据的获取分析;杨志然、刘福生、王建芳和李园负责起草或修改文章关键内容。
详细信息
    通信作者:

    陈润花,excillentcrh@126.com

Diagnostic value of transient elastography in the staging of hepatic fibrosis in patients with autoimmune liver disease: A Meta-analysis

  • 摘要:   目的  系统评价瞬时弹性成像技术(TE)对自身免疫性肝病肝纤维化分期的诊断价值。  方法  系统检索PubMed、Embase、Cochrane Library、中国知网、万方、维普数据库中已发表的关于TE诊断自身免疫性肝病肝纤维化分期的中、英文文献,检索时限为2000年1月—2021年1月,由2位评价员对纳入文献进行数据提取,采用文献质量评价工具QUADAS2进行文献质量评价,并应用Stata 15.0软件中双变量混合效应模型进行Meta分析。  结果  纳入11篇文献,共1041例患者。TE诊断显著肝纤维化(≥F2)的合并敏感度、特异度和AUC分别为0.81(95%CI: 0.75~0.86)、0.87(95%CI: 0.79~ 0.92)和0.91(95%CI: 0.88~0.93),诊断进展期肝纤维化(≥F3)的合并敏感度、特异度和AUC分别为0.81(95%CI 0.74~0.87)、0.90(95%CI0.85~0.93)和0.92(95%CI0.90~0.94),诊断早期肝硬化(F4)的合并敏感度、特异度和AUC分别为0.87(95%CI: 0.74~0.93)、0.93(95%CI: 0.87~0.97)和0.96(95%CI: 0.94~0.97)。  结论  TE对于评估自身免疫性肝病显著肝纤维化、进展期肝纤维化以及早期肝硬化均具有较好的诊断价值,尤其是对早期肝硬化的诊断准确度较高。

     

  • 图  1  文献筛选流程及结果

    图  2  QUADAS2质量评价结果

    图  3  TE诊断显著肝纤维化(≥F2)的合并敏感度和特异度的森林图

    图  4  TE诊断显著肝纤维化(≥F2)的SROC曲线

    图  5  TE诊断进展期肝纤维化(≥F3)的合并敏感度和特异度的森林图

    图  6  TE诊断进展期肝纤维化(≥F3)的SROC曲线

    图  7  TE诊断早期肝硬化(F4)的合并敏感度和特异度的森林图

    图  8  TE诊断早期肝硬化(F4)的SROC曲线

    图  9  总体SROC曲线

    表  1  纳入文献的基本特征

    项目 Corpe- chot等[10] Corpe- chot等[14] Corpe- chot等[11] Gómez- Doming- uez等[15] Ehlken等[13] Xu等[8] Flore- ani等[6] E Anas- tasiou等[16] Hartl等[12] Guo等[9] Wu等[7]
    发表年份 2014 2006 2012 2008 2016 2017 2011 2016 2016 2017 2018
    国家 法国 法国 法国 西班牙 德国 中国 意大利 德国 德国 中国 中国
    病因 PSC PBC、PSC PBC PBC PSC AIH PBC AIH AIH AIH OS
    病例数量(例) 73 101 103 80 139 100 120 53 94 108 70
    检查仪器 1 1 1 1 1 1 1 2 1 1 1
    F2
      AUC 0.84 0.92 0.91 NA 0.91 0.878 0.89 0.739 0.87 0.885 0.837
      敏感度 0.72 0.84 0.67 NA 0.815 0.821 0.82 0.586 0.9 0.846 0.902
      特异度 0.89 0.87 1 NA 0.886 0.875 0.92 0.833 0.72 0.767 0.778
      阳性预测值 0.85 0.91 1 NA 0.846 0.971 0.97 0.809 0.83 0.904 0.965
      阴性预测值 0.78 0.79 0.75 NA 0.861 0.486 0.59 0.624 0.84 0.657 0.538
    F3
      AUC 0.93 0.95 0.95 0.86 0.95 0.883 0.92 0.842 0.93 0.897 0.91
      敏感度 0.93 0.91 0.9 0.56 0.9 0.8 0.9 0.818 0.83 0.796 0.844
      特异度 0.83 0.9 0.93 1 0.905 0.84 0.92 0.929 0.98 0.852 0.921
      阳性预测值 0.61 0.84 0.84 1 0.818 0.836 0.9 0.757 0.92 0.843 0.9
      阴性预测值 0.98 0.95 0.96 0.83 0.95 0.805 0.92 0.951 0.91 0.807 0.875
    F4
      AUC 0.95 0.96 0.99 0.96 0.978 0.914 0.99 NA 0.96 0.878 0.966
      敏感度 1 0.93 0.93 0.88 0.688 0.87 0.99 NA 0.88 0.875 1
      特异度 0.88 0.95 0.99 0.98 0.978 0.896 0.94 NA 1 0.881 0.889
      阳性预测值 0.56 0.78 0.93 0.88 0.917 0.713 0.77 NA 1 0.963 0.5
      阴性预测值 1 0.99 0.99 0.98 0.9 0.959 1 NA 0.98 0.668 1
    注:在“检查仪器”中,“1”代表“Echosens, Paris, France”,“2”代表“Siemens Healthcare Erlangen, Germany Erlangen, Germany”。
    下载: 导出CSV

    表  2  主要肝功能指标

    作者 发表年份 ALT(U/L) AST(U/L)
    Corpechot等[10] 2014 68±60
    Corpechot等[14] 2006 60 52
    Corpechot等[11] 2012 76±64 60±44
    Gómez-Dominguez等[15] 2008
    Ehlken等[13] 2016 48 38
    Xu等[8] 2017 131.5±135.7 122.5±149.9
    Floreani等[6] 2011 44±36 36±20
    E Anastasiou等[16] 2016 606.42±131.13 418.09±96.87
    Hartl等[12] 2016 35.0±40.1
    Guo等[9] 2017 146.51±137.74 115.38±91.11
    Wu等[7] 2018 185.6±238.9 166.6±190.7
    下载: 导出CSV

    表  3  异质性检验、阈值效应、发表偏倚结果

    项目 显著肝纤维化
    (≥F2)
    进展期肝纤维化
    (≥F3)
    早期肝硬化
    (F4)
    P 结果 P 结果 P 结果
    异质性 <0.1 >0.1 >0.1
    阈值效应 1 1 0.95
    发表偏倚 0.37 0.98 0.14
    下载: 导出CSV
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  • 收稿日期:  2021-05-22
  • 录用日期:  2021-07-20
  • 出版日期:  2022-01-20
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