Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Digestive Center for Diagnosis and Treatment, Damascus, Syrian Arab Republic.
Clin Gastroenterol Hepatol. 2019 Jan;17(1):54-64.e1. doi: 10.1016/j.cgh.2018.08.069. Epub 2018 Sep 7.
BACKGROUND & AIMS: Transient elastography (TE) is a noninvasive technique used to measure liver stiffness to estimate the severity of fibrosis. The range of liver stiffness measurements (LSMs) in healthy individuals is unclear. We performed a systematic review to determine the range of LSMs, examined by TE, in healthy individuals and individuals who are susceptible to fibrosis.
We collected data from 16,082 individuals, in 26 cohorts, identified from systematic searches of Embase, Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for studies of liver stiffness measurements. Studies analyzed included apparently healthy adults (normal levels of liver enzymes, low-risk alcohol use patterns, and negative for markers of viral hepatitis). The presence of diabetes, hypertension, dyslipidemia, or steatosis, based on ultrasound examination, was known for most participants. We performed a meta-analysis of data from individual participants. The cohort was divided into 4 groups; participants with a body mass index <30 kg/m were examined with the medium probe and those with a body mass index ≥30 kg/m were examined with the extra-large probe. Linear regression models were conducted after adjusting for potential confounding factors of LSMs. We performed several sensitivity analyses.
We established LSM ranges for healthy individuals measured with both probes-these did not change significantly in sensitivity analyses of individuals with platelets ≥150,000/mm and levels of alanine aminotransferase ≤33 IU/L in men or ≤25 IU/L in women. In multivariate analysis, factors that modified LSMs with statistical significance included diabetes, dyslipidemia, waist circumference, level of aspartate aminotransferase, and systolic blood pressure at examination time. Significant increases in LSMs were associated with the metabolic syndrome in individuals examined by either probe. Diabetes in obese individuals increased the risk of LSMs in the range associated with advanced fibrosis.
In a systematic review and meta-analysis of data from individual participants, we established a comprehensive set of LSM ranges, measured by TE in large cohorts of healthy individuals and persons susceptible to hepatic fibrosis. Regression analyses identified factors associated with increased LSMs obtained by TE with the medium and extra-large probes.
瞬时弹性成像（TE）是一种非侵入性技术，用于测量肝硬度以估计纤维化的严重程度。健康个体的肝硬度测量值（LSM）范围尚不清楚。我们进行了一项系统评价，以确定 TE 检查中健康个体和易患纤维化个体的 LSM 范围。
我们从 Embase、Ovid MEDLINE、Cochrane 对照试验中心注册库和 Cochrane 系统评价数据库中系统搜索，收集了 26 个队列的 16082 名个体的数据，这些研究分析了肝硬度测量值。所分析的研究包括显然健康的成年人（肝脏酶水平正常、低风险饮酒模式且无病毒性肝炎标志物阳性）。大多数参与者的超声检查已知存在糖尿病、高血压、血脂异常或脂肪变性。我们对个体参与者的数据进行了荟萃分析。根据体重指数（BMI）将队列分为 4 组；BMI<30 kg/m 的个体使用中探头进行检查，BMI≥30 kg/m 的个体使用特大探头进行检查。调整 LSM 的潜在混杂因素后，进行线性回归模型分析。我们进行了几次敏感性分析。
我们建立了使用两种探头测量的健康个体的 LSM 范围-在血小板≥150,000/mm 和男性丙氨酸氨基转移酶（ALT）≤33 IU/L 或女性 ALT≤25 IU/L 的个体的敏感性分析中，这些范围没有显著变化。多变量分析中，有统计学意义的影响 LSM 的因素包括糖尿病、血脂异常、腰围、天冬氨酸氨基转移酶（AST）水平和检查时的收缩压。两种探头检查的个体中，代谢综合征与 LSM 显著增加相关。肥胖个体中的糖尿病增加了与晚期纤维化相关的 LSM 范围的风险。
在一项个体参与者数据的系统评价和荟萃分析中，我们在大规模健康个体和易患肝纤维化个体的队列中建立了一套全面的 LSM 范围。回归分析确定了与中探头和特大探头获得的 TE 相关的 LSM 增加相关的因素。
