He Lei, Deng Linfeng, Zhang Quan, Guo Jianli, Zhou Jinan, Song Wenjian, Yuan Fahu
Department of Blood Transfusion, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Laboratory Medicine, Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan, China.
Biomed Res Int. 2017;2017:9729107. doi: 10.1155/2017/9729107. Epub 2017 Feb 23.
Liver biopsy still remains the gold standard for diagnosing nonalcoholic steatohepatitis (NASH), but with limitations. There is an urgent need to develop noninvasive tests that accurately distinguish NASH from simple steatosis. The purpose of this meta-analysis was to evaluate the diagnostic value of serum biomarkers including cytokeratin 18 (CK-18), fibroblast growth factor 21 (FGF-21), and combined biomarker panel (CBP) in the diagnosis of NAFLD, especially NASH. A total of 25 studies met the inclusion criteria. Pooled sensitivity and specificity values for chosen serum markers for diagnosing NASH are as follows: CK-18 (M30), 0.75 and 0.77; CK-18 (M65), 0.71 and 0.77; FGF-21, 0.62 and 0.78; and CBP, 0.92 and 0.85. CBP demonstrated better accuracy with higher sensitivity and specificity than those tested individually. Furthermore, the AUROC of CBP was 0.94 (95% CI, 0.92-0.96), compared to CK-18 or FGF-21 assay, which showed the most significant ability to distinguish NASH from simple steatosis. The results suggest that increased circulating CK-18 and FGF-21 are associated with NASH and may be used for initial assessment, but not enough. Importantly, CBP is potentially used as accurate diagnostic tools for NASH. Further prospective designed studies are warranted to confirm our findings.
肝活检仍然是诊断非酒精性脂肪性肝炎（NASH）的金标准，但存在局限性。迫切需要开发能够准确区分NASH与单纯性脂肪变性的非侵入性检测方法。本荟萃分析的目的是评估包括细胞角蛋白18（CK-18）、成纤维细胞生长因子21（FGF-21）和联合生物标志物组（CBP）在内的血清生物标志物在非酒精性脂肪性肝病（NAFLD）尤其是NASH诊断中的价值。共有25项研究符合纳入标准。用于诊断NASH的所选血清标志物的合并敏感性和特异性值如下：CK-18（M30），0.75和0.77；CK-18（M65），0.71和0.77；FGF-21，0.62和0.78；CBP，0.92和0.85。与单独检测相比，CBP表现出更高的准确性，具有更高的敏感性和特异性。此外，CBP的受试者工作特征曲线下面积（AUROC）为0.94（95%CI，0.92-0.96），而CK-18或FGF-21检测的AUROC显示区分NASH与单纯性脂肪变性的能力最强。结果表明，循环中CK-18和FGF-21升高与NASH相关，可用于初步评估，但还不够。重要的是，CBP有可能作为NASH的准确诊断工具。有必要进行进一步的前瞻性设计研究来证实我们的发现。
