Lian Ming-Jian, Zhang Jia-Qin, Chen Shi-Dong, Zhang Dong-Dong, Yang Yuan-Yuan, Hong Guo-Lin
Department of Clinical Laboratory, The First Affiliated Hospital of Xiamen University, Xiamen.
Medical Department, Fujian Medical University, Fuzhou, Fujian Province, China.
Eur J Gastroenterol Hepatol. 2019 May;31(5):599-606. doi: 10.1097/MEG.0000000000001381.
Emerging published data on the accuracy of γ-glutamyl transpeptidase-to-platelet ratio (GPR) for diagnosing hepatitis B virus (HBV)-related fibrosis are inconsistent. The aim of this study was to systematically review the performance of GPR for diagnosing HBV-related significant fibrosis, severe fibrosis, and cirrhosis.
A comprehensive literature search of PubMed, Web of Science, and EMBASE was conducted before July 2018. Study selection was performed according to inclusion and exclusion criteria. The relevant parameters of eligible studies were abstracted. The methodological quality was assessed according to the Quality Assessment of Diagnostic Accuracy Studies. Areas under summary receiver operating characteristic curves, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratios were used to examine the GPR accuracy for the diagnosis of significant fibrosis, severe fibrosis, and cirrhosis.
A total of 10 studies including 5882 patients with HBV infection underwent liver biopsy were incorporated. The prevalence of significant fibrosis, severe fibrosis, and cirrhosis were 58% (range: 22-72%), 36% (range: 10-55%), and 19% (range: 2-33%), respectively. Areas under summary receiver operating characteristic curves of GPR for predicting significant fibrosis, severe fibrosis, and cirrhosis were 0.733, 0.777, and 0.796, respectively. Subgroup analysis was performed according to geographical region and histological scoring system with similar results.
GPR has moderate diagnostic accuracy for predicting HBV-related significant fibrosis, severe fibrosis, and cirrhosis, and further studies with large sample size, rigorous design, multicenter study population are urgently needed.
关于γ-谷氨酰转肽酶与血小板比值（GPR）诊断乙型肝炎病毒（HBV）相关纤维化准确性的新发表数据并不一致。本研究的目的是系统评价GPR诊断HBV相关显著纤维化、严重纤维化和肝硬化的性能。
2018年7月前对PubMed、Web of Science和EMBASE进行了全面的文献检索。根据纳入和排除标准进行研究选择。提取符合条件研究的相关参数。根据诊断准确性研究的质量评估对方法学质量进行评估。采用汇总受试者工作特征曲线下面积、灵敏度、特异度、阳性似然比、阴性似然比和诊断比值比来检验GPR诊断显著纤维化、严重纤维化和肝硬化的准确性。
共纳入10项研究，包括5882例接受肝活检的HBV感染患者。显著纤维化、严重纤维化和肝硬化的患病率分别为58%（范围：22%-72%）、36%（范围：10%-55%）和19%（范围：2%-33%）。GPR预测显著纤维化、严重纤维化和肝硬化的汇总受试者工作特征曲线下面积分别为0.733、0.777和0.796。根据地理区域和组织学评分系统进行亚组分析，结果相似。
GPR在预测HBV相关显著纤维化、严重纤维化和肝硬化方面具有中等诊断准确性，迫切需要进一步开展大样本量、设计严谨、多中心研究人群的研究。
