瞬时弹性成像技术对慢性肝病肝纤维化分期诊断价值的meta分析

摘要

背景:早期诊断肝纤维化并对其进行正确的分期,对评估患者的预后和生存具有极为重要的意义.目的:系统评价瞬时弹性成像技术(TE)对慢性肝病肝纤维化分期的诊断价值.方法:系统检索2001年1月-2015年12月PubMed、Embase、Cochrane Library、中国知网、万方、维普数据库,纳入TE诊断慢性肝病患者肝纤维化分期的文献,对纳入文献进行数据提取,采用诊断准确性研究的质量评价工具2(QUADAS2)行文献质量评价,并应用Stata 12.0软件行meta分析.结果:纳入20篇文献共5 748例患者.Meta分析显示,TE诊断显著肝纤维化(≥F2)的合并敏感性、特异性和AUC分别为0.78(95％ CI: 0.73～0.82)、0.85(95％ CI: 0.80～0.88)和0.88(95％ CI: 0.85～0.91),诊断进展期肝纤维化(≥F3)的合并敏感性、特异性和AUC分别为0.89(95％ CI: 0.86～0.91)、0.88(95％ CI: 0.85～0.91)和0.94(95％ CI: 0.92～0.96),诊断肝硬化(F4)的合并敏感性、特异性和AUC分别为0.91(95％ CI: 0.86～0.95)、0.89(95％ CI: 0.87～0.92)和0.95(95％ CI: 0.93～0.97).结论:TE对于评估慢性肝病显著肝纤维化、进展期肝纤维化以及肝硬化具有较好的诊断价值,尤其适用于进展期肝纤维化以及肝硬化的诊断.%Background: Early diagnosis and staging of liver fibrosis are important for the prognosis and evaluating the survival of patients.Aims: To systematically assess the diagnostic value of transient elastography (TE) for staging of liver fibrosis in patients with chronic liver disease.Methods: PubMed,Embase,Cochrane Library,CNKI,Wanfang and VIP from Jan.2001 to Dec.2015 were retrieved to collect the articles with staging of liver fibrosis in patients with chronic liver disease by TE.Data extraction was conducted.Article quality was evaluated by quality assessment of diagnostic accuracy studies 2 (QUADAS2).Meta-analysis was conducted by Stata 12.0 software.Results: Twenty articles involving 5 748 patients were included.Meta-analysis showed that the combined sensitivity,specificity and AUC of TE for diagnosing significant fibrosis (≥F2) were 0.78 (95％ CI: 0.73-0.82),0.85 (95％ CI: 0.80-0.88) and 0.88 (95％ CI: 0.85-0.91),respectively.The combined sensitivity,specificity and AUC for advanced fibrosis (≥F3) were 0.89 (95％ CI: 0.86-0.91),0.88 (95％ CI: 0.85-0.91) and 0.94 (95％ CI: 0.92-0.96),respectively.The combined sensitivity,specificity and AUC for cirrhosis (F4) were 0.91 (95％ CI: 0.86-0.95),0.89 (95％ CI: 0.87-0.92) and 0.95 (95％ CI: 0.93-0.97),respectively.Conclusions: TE technique has a good diagnostic value in assessing significant fibrosis,advanced fibrosis and cirrhosis in patients with chronic liver disease,especially for advanced fibrosis and cirrhosis.