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

doi:10.3969/j.issn.1001-5256.2022.01.015

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

杨志然¹,
王林恒^2a,
李园¹,
刘福生^2b,
王雨¹,
王建芳^2a,
陈润花^2a, ,

1.
北京中医药大学第二临床医学院，北京 100029
2a.
北京中医药大学东方医院脾胃肝胆科，北京 100078
2b.
北京中医药大学东方医院急诊科，北京 100078

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

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出版历程
- 收稿日期: 2021-05-22
- 录用日期: 2021-07-20
- 出版日期: 2022-01-20

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

1.
The Second Clinical Medical College of Beijing University of Chinese Medicine, Beijing 100029, China
2a.
Department of Spleen-stomach, Liver-gallbladder, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
2b.
Emergency Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China

摘要

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。
- 肝硬化 /
- 自身免疫疾病 /
- 弹性成像技术 /
- Meta分析(主题)
Abstract: Objective To investigate the value of transient elastography (TE) in the staging of hepatic fibrosis in patients with autoimmune liver disease (ALD). Methods PubMed, Embase, the Cochrane Library, CNKI, Wanfang Data, and VIP databases were searched for English and Chinese articles on TE in the staging of hepatic fibrosis in ALD published from January 2000 to January 2021. Two reviewers independently performed data extraction for the articles included, and QUADAS2 was used for quality assessment. The bivariate mixed effects model in Stata 15.0 software was used to perform the Meta-analysis. Results A total of 11 articles were included, with 1041 patients in total. In the diagnosis of significant hepatic fibrosis (F≥2), TE had a pooled sensitivity of 0.81 (95% CI: 0.75-0.86), a specificity of 0.87(95%CI 0.79-0.92), and an area under the receiver operating characteristic curve (AUC) of 0.91(95%CI 0.88-0.93); in the diagnosis of advanced hepatic fibrosis (F≥3), TE had a pooled sensitivity of 0.81(95%CI 0.74-0.87), a sensitivity of 0.90(95%CI 0.85-0.93), and an AUC of 0.92(95%CI 0.90-0.94); in the diagnosis of early-stage liver cirrhosis (F4), TE had a pooled sensitivity of 0.87(95%CI 0.74-0.93), a specificity of 0.93(95%CI 0.87-0.97), and an AUC of 0.96(95%CI 0.94-0.97). Conclusion TE has a good diagnostic value in evaluating significant liver fibrosis, advanced liver fibrosis, and early-stage liver cirrhosis in patients with ALD, especially with a relatively high diagnostic accuracy for early-stage liver cirrhosis.
- Liver Cirrhosis /
- Autoimmune Diseases /
- Elasticity Imaging Techniques /
- Meta-Analysis as Topic

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图 1 文献筛选流程及结果

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图 2 QUADAS2质量评价结果

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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

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图 4 TE诊断显著肝纤维化(≥F2)的SROC曲线

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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

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图 6 TE诊断进展期肝纤维化(≥F3)的SROC曲线

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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

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图 8 TE诊断早期肝硬化(F4)的SROC曲线

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图 9 总体SROC曲线

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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”。

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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

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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)
项目	P值	结果	P值	结果	P值	结果
异质性	＜0.1	有	＞0.1	无	＞0.1	无
阈值效应	1	无	1	无	0.95	无
发表偏倚	0.37	无	0.98	无	0.14	无

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