脾脏硬度评估慢性肝病门静脉高压和食管静脉曲张的诊断准确性：系统评价和荟萃分析。
Diagnostic accuracy of spleen stiffness to evaluate portal hypertension and esophageal varices in chronic liver disease: a systematic review and meta-analysis.
机构信息
Ultrasound and Functional Diagnosis Center, Beijing Youan Hospital, Capital Medical University, No. 8, Xitoutiao, Youanmenwai, Fengtai District, Beijing, 100069, China.
Center for Infectious Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China.
出版信息
Eur Radiol. 2021 Apr;31(4):2392-2404. doi: 10.1007/s00330-020-07223-8. Epub 2020 Sep 24.
OBJECTIVES
To systematically review studies on the diagnostic accuracy of spleen stiffness measurement (SSM) for the detection of clinical significant portal hypertension (CSPH), severe portal hypertension (SPH), esophageal varices (EV), and high-risk esophageal varices (HREV) in patients with chronic liver diseases (CLD).
METHODS
Through a systematic search, we identified 32 studies reporting the accuracy of SSM for the diagnosis of portal hypertension (PH) and/or EV in adults with CLD. A bivariate random-effects model was performed to estimate pooled sensitivity, specificity, likelihood ratio, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratios (DOR). The clinical utility of SSM was evaluated by Fagan plot.
RESULTS
A total of 32 studies assessing 3952 patients were included in this meta-analysis. The pooled sensitivities of SSM were 0.85 (95% confidence interval (CI), 0.69-0.93) for CSPH; 0.84 (95% CI, 0.75-0.90) for SPH; 0.90 (95% CI, 0.83-0.94) for any EV; and 0.87 (95% CI, 0.77-0.93) for HREV. The pooled specificities of SSM were 0.86 (95% CI, 0.74-0.93) for CSPH; 0.84 (95% CI, 0.72-0.91) for SPH; 0.73 (95% CI, 0.66-0.79) for EV; and 0.66 (95% CI, 0.53-0.77) for HREV. Summary PPV and NPV of SSM for detecting HREV were 0.54 (95% CI, 0.47-0.62) and 0.88 (95% CI, 0.81-0.95), respectively.
CONCLUSIONS
Our meta-analysis suggests that SSM could be used as a helpful surveillance tool in management of CLD patients and was quite useful for ruling out the presence of HREV thereby avoiding unnecessary endoscopy.
KEY POINTS
• SSM could be used to rule out the presence of HREV in patients with CLD thereby avoiding unnecessary endoscopy. • SSM has significant diagnostic value for CSPH and SPH with high sensitivity and specificity in patients with CLD. • SSM could be used as a helpful surveillance tool for clinicians managing CLD patients.
目的
系统评价脾脏硬度测量（SSM）诊断慢性肝病（CLD）患者临床显著门静脉高压（CSPH）、严重门静脉高压（SPH）、食管静脉曲张（EV）和高危食管静脉曲张（HREV）的准确性。
方法
通过系统检索，我们确定了 32 项研究报告了 SSM 诊断成人 CLD 患者 PH 和/或 EV 的准确性。采用双变量随机效应模型估计汇总敏感性、特异性、似然比、阳性预测值（PPV）、阴性预测值（NPV）和诊断比值比（DOR）。通过 Fagan 图评估 SSM 的临床实用性。
结果
本荟萃分析共纳入 32 项研究 3952 例患者。SSM 诊断 CSPH 的汇总敏感性为 0.85（95%置信区间（CI），0.69-0.93）；SPH 为 0.84（95%CI，0.75-0.90）；任何 EV 为 0.90（95%CI，0.83-0.94）；HREV 为 0.87（95%CI，0.77-0.93）。SSM 诊断 CSPH 的汇总特异性为 0.86（95%CI，0.74-0.93）；SPH 为 0.84（95%CI，0.72-0.91）；EV 为 0.73（95%CI，0.66-0.79）；HREV 为 0.66（95%CI，0.53-0.77）。SSM 诊断 HREV 的汇总 PPV 和 NPV 分别为 0.54（95%CI，0.47-0.62）和 0.88（95%CI，0.81-0.95）。
结论
本荟萃分析表明，SSM 可作为 CLD 患者管理的有用监测工具，对于排除 HREV 的存在非常有用，从而避免不必要的内镜检查。
关键点
SSM 可用于排除 CLD 患者 HREV 的存在，从而避免不必要的内镜检查。
SSM 对 CLD 患者的 CSPH 和 SPH 具有较高的敏感性和特异性，具有显著的诊断价值。
SSM 可作为 CLD 患者临床医生管理的有用监测工具。
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