Cheng Fan, Cao Hongyan, Liu Jinchun, Jiang Lijun, Han Hongjuan, Zhang Yanbo, Guo Dongxing
Department of Health Statistics, School of Public Health Department of Mathematics, School of Basic Medicine, Shanxi Medical University Department of Gastroenterology, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China Molecular Imaging Precision Medicine Collaborative Innovation Center, Shanxi Medical University,Taiyuan, Shanxi, China.
Medicine (Baltimore). 2018 Jul;97(28):e11368. doi: 10.1097/MD.0000000000011368.
To assess the diagnostic performance of transient elastography (TE) in detecting the presence and size of esophageal varices (EV) in cirrhotic patients.
We searched PubMed, Web of Science, Wiley Online Library, Science Direct, China National Knowledge Infrastructure, WeiPu, WanFang database, and Baidu Scholar to identify studies that evaluated the diagnostic accuracy of TE in liver stiffness measurement, compared with esophagogastroduodenoscopy (EGD), for the detection of the presence and degree of EV in cirrhosis.
We included 32 studies in the presence of any EV (grade 1-3; n = 4082), 27 studies on substantial EV (grade 2-3; n = 5221) and 5 studies on large EV (grade 3). The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were 0.8 (95% CI, 0.78-0.86), 0.68 (95% CI, 0.62-0.74), and 10 (95% CI, 7-14) for any EV; 0.81 (95% CI, 0.77-0.85), 0.72 (95% CI, 0.66-0.77), and 11 (95% CI, 8-15) for substantial EV; and 0.92 (95% CI, 0.83-0.96), 0.78 (95% CI, 0.70-0.85), and 40 (95% CI, 15-107) for large EV. Subgroup analysis revealed that the heterogeneity among studies on any EV could potentially be explained by study location, proportion of Child A, and time interval between TE and EGD; for substantial EV, the proportion of Child A, etiology of cirrhosis, and the time interval between TE and EGD were important heterogeneity factors. Publication bias was found among studies evaluating diagnostic performance of TE for any EV.
TE is a good tool for detecting the presence and degree of EV; however, in determination of the liver stiffness cutoff values means that TE is only cautiously used in clinical practice.
评估瞬时弹性成像（TE）检测肝硬化患者食管静脉曲张（EV）的存在及大小的诊断性能。
我们检索了PubMed、科学网、Wiley在线图书馆、Science Direct、中国知网、维普、万方数据库和百度学术，以确定评估TE在肝硬度测量中诊断准确性的研究，这些研究与食管胃十二指肠镜检查（EGD）相比，用于检测肝硬化中EV的存在及程度。
我们纳入了32项关于任何食管静脉曲张（1-3级；n = 4082）的研究、27项关于显著食管静脉曲张（2-3级；n = 5221）的研究和5项关于大型食管静脉曲张（3级）的研究。对于任何食管静脉曲张，汇总敏感性、特异性和诊断比值比（DOR）分别为0.8（95%CI，0.78-0.86）、0.68（95%CI，0.62-0.74）和10（95%CI，7-14）；对于显著食管静脉曲张，分别为0.81（95%CI，0.77-0.85）、0.72（95%CI，0.66-0.77）和11（95%CI，8-15）；对于大型食管静脉曲张，分别为0.92（95%CI，0.83-0.96）、0.78（95%CI，0.70-0.85）和40（95%CI，15-107）。亚组分析显示，关于任何食管静脉曲张的研究之间的异质性可能由研究地点、Child A比例以及TE与EGD之间的时间间隔来解释；对于显著食管静脉曲张，Child A比例、肝硬化病因以及TE与EGD之间的时间间隔是重要的异质性因素。在评估TE对任何食管静脉曲张诊断性能的研究中发现了发表偏倚。
TE是检测食管静脉曲张的存在及程度的良好工具；然而，在确定肝硬度临界值方面意味着TE在临床实践中仅谨慎使用。
