Cancer Center, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hepatology. 2017 Nov;66(5):1486-1501. doi: 10.1002/hep.29302. Epub 2017 Sep 26.
Many noninvasive methods for diagnosing liver fibrosis (LF) have been proposed. To determine the best method for diagnosing LF in nonalcoholic fatty liver disease (NAFLD), we conducted a systemic review and meta-analysis to compare the performance of aspartate aminotransferase to platelets ratio index (APRI), fibrosis-4 index (FIB-4), BARD score, NAFLD fibrosis score (NFS), FibroScan, shear wave elastography (SWE), and magnetic resonance elastography (MRE) for diagnosing LF in NAFLD. We compared the sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUROC) of these noninvasive methods for detecting significant fibrosis (SF), advanced fibrosis (AF), and cirrhosis. Heterogeneity was explored using meta-regression. Sixty-four articles with a total of 13,046 NAFLD subjects were included. The overall mean prevalence of SF, AF, and cirrhosis was 45.0%, 24.0%, and 9.4% in NAFLD patients, respectively. With an APRI threshold of 1.0 and 1.5, the sensitivities and specificities were 50.0% and 84.0% and 18.3% and 96.1%, respectively, for AF. With a FIB-4 threshold of 2.67 and 3.25, the sensitivities and specificities were 26.6% and 96.5% and 31.8% and 96.0%, respectively, for AF. The summary sensitivities and specificities of BARD score (threshold of 2), NFS (threshold of -1.455), FibroScan M (threshold of 8.7-9), SWE, and MRE for detecting AF were 0.76 and 0.61, 0.72 and 0.70, 0.87 and 0.79, 0.90 and 0.93, and 0.84 and 0.90, respectively. The summary AUROC values using APRI, FIB-4, BARD score, NFS, FibroScan M probe, XL probe, SWE, and MRE for diagnosing AF were 0.77, 0.84, 0.76, 0.84, 0.88, 0.85, 0.95, and 0.96, respectively.
MRE and SWE may have the highest diagnostic accuracy for staging fibrosis in NAFLD patients. Among the four noninvasive simple indexes, NFS and FIB-4 probably offer the best diagnostic performance for detecting AF. (Hepatology 2017;66:1486-1501).
评估各种非侵入性方法诊断非酒精性脂肪性肝病（NAFLD）患者肝纤维化（LF）的准确性，旨在为临床选择最佳的 LF 诊断方法。
我们对相关文献进行了系统性回顾和荟萃分析，比较了天冬氨酸氨基转移酶与血小板比值指数（APRI）、纤维化-4 指数（FIB-4）、BARD 评分、NAFLD 纤维化评分（NFS）、FibroScan、剪切波弹性成像（SWE）和磁共振弹性成像（MRE）在诊断 NAFLD 患者 LF 中的应用。我们比较了这些非侵入性方法检测显著纤维化（SF）、进展性纤维化（AF）和肝硬化的灵敏度、特异度、阳性预测值、阴性预测值和受试者工作特征曲线下面积（AUROC）。使用荟萃回归探索异质性。
共纳入 64 项研究，包含 13046 例 NAFLD 患者。NAFLD 患者 SF、AF 和肝硬化的总体平均患病率分别为 45.0%、24.0%和 9.4%。APRI 界值为 1.0 和 1.5 时，AF 的灵敏度和特异度分别为 50.0%和 84.0%和 18.3%和 96.1%。FIB-4 界值为 2.67 和 3.25 时，AF 的灵敏度和特异度分别为 26.6%和 96.5%和 31.8%和 96.0%。BARD 评分（界值 2）、NFS（界值-1.455）、FibroScan M（界值 8.7-9）、SWE 和 MRE 诊断 AF 的汇总灵敏度和特异度分别为 0.76 和 0.61、0.72 和 0.70、0.87 和 0.79、0.90 和 0.93、0.84 和 0.90。使用 APRI、FIB-4、BARD 评分、NFS、FibroScan M 探头、XL 探头、SWE 和 MRE 诊断 AF 的 AUROC 值分别为 0.77、0.84、0.76、0.84、0.88、0.85、0.95 和 0.96。
MRE 和 SWE 可能具有诊断 NAFLD 患者肝纤维化的最高准确性。在这 4 个非侵入性简单指标中，NFS 和 FIB-4 可能是诊断 AF 的最佳方法。
