National Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, CB18RN, UK.
Hepatol Int. 2019 Jan;13(1):91-101. doi: 10.1007/s12072-018-9907-5. Epub 2018 Nov 15.
Non-invasive fibrosis assessment has been highly recommended in many liver diseases. However, comparative diagnostic accuracy of laboratory markers, ultrasound and magnetic resonance elastography (MRE) for fibrosis in autoimmune hepatitis (AIH) patients has not been established.
Medline, Embase and Cochrane Library were searched. Primary outcome was significant fibrosis (SF), advanced fibrosis (AF) and cirrhosis, defined as Metavir stage F ≥ 2, F ≥ 3 and F = 4 according to liver biopsy. Hierarchical summary receiver operating characteristic curve (ROC) model was used to evaluate diagnostic accuracy of non-invasive methods. Summary area under ROC (AUROC) and diagnostic odds ratio (DOR) with 95% confidence interval (CI) were calculated. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess quality of evidence.
Overall, 16 studies with 861 patients were included, comparing aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 index (FIB-4), aspartate aminotransferase/alanine aminotransferase ratio, transient elastography (TE), acoustic radiation force impulse, shear wave elastography and MRE versus liver biopsy. Among all non-invasive markers, TE had good performance for fibrosis staging. Summary AUROCs and DORs of TE were 0.90 (95% CI 0.87, 0.92) and 23.7, 0.91 (95% CI 0.89, 0.93) and 31.6, 0.89 (95% CI 0.86, 0.92) and 80.5 for staging SF, AF and cirrhosis, whereas APRI and FIB-4 showed poor performance for detecting AF (DOR, 4.6 and 4.7) and cirrhosis (DOR, 5.5 and 12.9).
TE performs well to stage liver fibrosis in patients with AIH, compared with other laboratory non-invasive indexes. Nevertheless, diagnostic accuracy of APRI and FIB-4 is poor.
在许多肝脏疾病中，非侵入性纤维化评估得到了高度推荐。然而，对于自身免疫性肝炎（AIH）患者的纤维化，实验室标志物、超声和磁共振弹性成像（MRE）的比较诊断准确性尚未确定。
检索了 Medline、Embase 和 Cochrane Library。主要结局为显著纤维化（SF）、晚期纤维化（AF）和肝硬化，定义为根据肝活检的 Metavir 分期 F≥2、F≥3 和 F=4。使用分层汇总受试者工作特征曲线（ROC）模型评估非侵入性方法的诊断准确性。计算汇总 ROC 曲线下面积（AUROC）和诊断比值比（DOR）及其 95%置信区间（CI）。使用推荐评估、制定和评估系统（Grading of Recommendations Assessment, Development and Evaluation system）评估证据质量。
共纳入 16 项研究，共 861 例患者，比较天门冬氨酸氨基转移酶/血小板比值指数（APRI）、纤维化-4 指数（FIB-4）、天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值、瞬时弹性成像（TE）、声辐射力脉冲、剪切波弹性成像和 MRE 与肝活检。在所有非侵入性标志物中，TE 对纤维化分期具有良好的性能。TE 的汇总 AUROC 和 DOR 分别为 0.90（95%CI 0.87，0.92）和 23.7、0.91（95%CI 0.89，0.93）和 31.6、0.89（95%CI 0.86，0.92）和 80.5，用于分期 SF、AF 和肝硬化，而 APRI 和 FIB-4 对检测 AF（DOR，4.6 和 4.7）和肝硬化（DOR，5.5 和 12.9）的性能较差。
与其他实验室非侵入性指标相比，TE 对 AIH 患者的肝纤维化分期效果良好。然而，APRI 和 FIB-4 的诊断准确性较差。
