瞬时弹性成像评估肝纤维化和脂肪变性：基于证据的分析
Transient Elastography for Assessment of Liver Fibrosis and Steatosis: An Evidence-Based Analysis.
作者信息
Brener S
出版信息
Ont Health Technol Assess Ser. 2015 Nov 1;15(18):1-45. eCollection 2015.
BACKGROUND
Liver fibrosis is a sign of advanced liver disease and is often an indication for treatment. The current standard for diagnosing liver fibrosis and steatosis is biopsy, but noninvasive alternatives are available; one of the most common is transient elastography (FibroScan).
OBJECTIVES
The objective of this analysis was to assess the diagnostic accuracy and clinical utility of transient elastography alone for liver fibrosis and with controlled attenuation parameter (CAP) for steatosis in patients with hepatitis C virus, hepatitis B virus, nonalcoholic fatty liver disease, alcoholic liver disease, or cholestatic diseases. The analysis also aimed to compare the diagnostic accuracy of transient elastography with two alternative noninvasive technologies: FibroTest and acoustic force radiation impulse (ARFI).
DATA SOURCES
Ovid MEDLINE, Ovid MEDLINE In-Process, Ovid Embase, and all EBM databases were searched for all studies published prior to October 2, 2014.
REVIEW METHODS
An overview of reviews was conducted using a systematic search and assessment approach. The results of the included systematic reviews were summarized, analyzed, and reported for outcomes related to diagnostic accuracy and clinical utility as a measure of impact on diagnoses, therapeutic decisions, and patient outcomes.
RESULTS
Fourteen systematic reviews were included, summarizing more than 150 studies. The reviews demonstrated that transient elastography (with or without CAP) has good diagnostic accuracy compared to biopsy for the assessment of liver fibrosis and steatosis. Acoustic force radiation impulse and FibroTest were not superior to transient elastography.
LIMITATIONS
None of the included systematic reviews reported on the clinical utility of transient elastography.
CONCLUSIONS
Transient elastography (with or without CAP) offers a noninvasive alternative to biopsy for the assessment of liver fibrosis and steatosis, given its comparable diagnostic accuracy.
背景
肝纤维化是晚期肝病的一个标志，通常也是治疗的指征。目前诊断肝纤维化和脂肪变性的标准是活检，但也有非侵入性的替代方法；最常见的一种是瞬时弹性成像（FibroScan）。
目的
本分析的目的是评估单独使用瞬时弹性成像诊断丙型肝炎病毒、乙型肝炎病毒、非酒精性脂肪性肝病、酒精性肝病或胆汁淤积性疾病患者肝纤维化的诊断准确性和临床实用性，以及使用受控衰减参数（CAP）诊断脂肪变性的准确性和临床实用性。该分析还旨在比较瞬时弹性成像与另外两种非侵入性技术：FibroTest和声辐射力脉冲（ARFI）的诊断准确性。
数据来源
检索了Ovid MEDLINE、Ovid MEDLINE 正在进行中的数据、Ovid Embase以及所有循证医学数据库，查找2014年10月2日前发表的所有研究。
综述方法
采用系统检索和评估方法进行综述概述。对纳入的系统综述结果进行总结、分析，并报告与诊断准确性和临床实用性相关的结果，以此作为对诊断、治疗决策和患者预后影响的衡量指标。
结果
纳入了14篇系统综述，总结了150多项研究。这些综述表明，与活检相比，瞬时弹性成像（无论有无CAP）在评估肝纤维化和脂肪变性方面具有良好的诊断准确性。声辐射力脉冲和FibroTest并不优于瞬时弹性成像。
局限性
纳入的系统综述均未报告瞬时弹性成像的临床实用性。
结论
鉴于其可比的诊断准确性，瞬时弹性成像（无论有无CAP）为评估肝纤维化和脂肪变性提供了一种活检的非侵入性替代方法。
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