Li Y, Huang Y-S, Wang Z-Z, Yang Z-R, Sun F, Zhan S-Y, Liu X-E, Zhuang H
Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China.
Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China.
Aliment Pharmacol Ther. 2016 Feb;43(4):458-69. doi: 10.1111/apt.13488. Epub 2015 Dec 15.
Transient elastography is a non-invasive method for staging liver fibrosis. The meta-analysis using the hierarchical models to evaluate the diagnostic accuracy of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B was rarely reported.
A meta-analysis using the hierarchical models was performed to assess transient elastography for diagnosing and stage liver fibrosis in patients with chronic hepatitis B.
Electronic databases were searched and studies were identified to assess the diagnostic accuracy of transient elastography in CHB patients for staging fibrosis F ≥ 2, F ≥ 3 and F = 4 with liver biopsy as a reference standard. The hierarchical summary receiver operating characteristic curve and the bivariate models were performed to evaluate the diagnostic accuracy of transient elastography, and meta-regression analyses were performed to explore the heterogeneity. The quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the quality of studies.
Twenty-seven studies with a total of 4386 patients were included in the meta-analysis. The summary sensitivity of transient elastography for staging fibrosis F ≥ 2, F ≥ 3 and F = 4 was 0.806 (95% CI, 0.756-0.847), 0.819 (95% CI, 0.748-0.874) and 0.863 (95% CI, 0.818-0.898), respectively, and the summary specificity was 0.824 (95% CI, 0.761-0.873), 0.866 (95% CI, 0.824-0.899) and 0.875 (95% CI, 0.840-0.903), respectively. The corresponding area under the summary receiver operating characteristic curve was 0.88 (95% CI, 0.85-0.91), 0.91 (95% CI, 0.88-0.93) and 0.93 (95% CI, 0.91-0.95), respectively. Meta-regression showed that patient age contributed to heterogeneity.
Transient elastography performs well to diagnose liver fibrosis in patients with chronic hepatitis B, which may reduce the use of liver biopsy.
瞬时弹性成像术是一种用于肝纤维化分期的非侵入性方法。利用分层模型评估瞬时弹性成像术对慢性乙型肝炎患者肝纤维化分期诊断准确性的荟萃分析鲜有报道。
进行一项使用分层模型的荟萃分析，以评估瞬时弹性成像术对慢性乙型肝炎患者肝纤维化的诊断及分期情况。
检索电子数据库并确定相关研究，以肝活检作为参考标准，评估瞬时弹性成像术对慢性乙型肝炎患者肝纤维化分期为F≥2、F≥3和F = 4的诊断准确性。采用分层汇总受试者工作特征曲线和双变量模型评估瞬时弹性成像术的诊断准确性，并进行荟萃回归分析以探讨异质性。使用诊断准确性研究质量评估-2工具评估研究质量。
荟萃分析纳入了27项研究，共4386例患者。瞬时弹性成像术对肝纤维化分期F≥2、F≥3和F = 4的汇总敏感度分别为0.806（95%可信区间，0.756 - 0.847）、0.819（95%可信区间，0.748 - 0.874）和0.863（95%可信区间，0.818 - 0.898），汇总特异度分别为0.824（95%可信区间，0.761 - 0.873）、0.866（95%可信区间，0.824 - 0.899）和0.875（95%可信区间，0.840 - 0.903）。相应的汇总受试者工作特征曲线下面积分别为0.88（95%可信区间，0.85 - 0.91）、0.91（95%可信区间，0.88 - 0.93）和0.93（95%可信区间，0.91 - 0.95）。荟萃回归显示患者年龄是异质性的一个影响因素。
瞬时弹性成像术在诊断慢性乙型肝炎患者肝纤维化方面表现良好，这可能会减少肝活检的使用。
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