磁共振弹性成像肝硬度值和 MEFIB 指数与非酒精性脂肪性肝病肝脏相关结局的关系：一项个体参与者的系统评价和荟萃分析。
Liver Stiffness on Magnetic Resonance Elastography and the MEFIB Index and Liver-Related Outcomes in Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Individual Participants.
机构信息
NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California; Division of Gastroenterology, University of California at San Diego, La Jolla, California.
NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
出版信息
Gastroenterology. 2022 Oct;163(4):1079-1089.e5. doi: 10.1053/j.gastro.2022.06.073. Epub 2022 Jul 2.
BACKGROUND & AIMS: Magnetic resonance elastography (MRE) is an accurate biomarker of liver fibrosis; however, limited data characterize its association with clinical outcomes. We conducted an individual participant data pooled meta-analysis on patients with nonalcoholic fatty liver disease to evaluate the association between liver stiffness on MRE and liver-related outcomes.
METHODS
A systematic search identified 6 cohorts of adults with nonalcoholic fatty liver disease who underwent a baseline MRE and were followed for hepatic decompensation, hepatocellular carcinoma, and death. Cox and logistic regression were used to assess the association between liver stiffness on MRE and liver-related outcomes, including a composite primary outcome defined as varices needing treatment, ascites, and hepatic encephalopathy.
RESULTS
This individual participant data pooled meta-analysis included 2018 patients (53% women) with a mean (± standard deviation) age of 57.8 (±14) years and MRE at baseline of 4.15 (±2.19) kPa, respectively. Among 1707 patients with available longitudinal data with a median (interquartile range) of 3 (4.2) years of follow-up, the hazard ratio for the primary outcome for MRE of 5 to 8 kPa was 11.0 (95% confidence interval [CI]: 7.03-17.1, P < .001) and for ≥ 8 kPa was 15.9 (95% CI: 9.32-27.2, P < .001), compared with those with MRE <5 kPa. The MEFIB index (defined as positive when MRE ≥3.3 kPa and Fibrosis-4 ≥1.6) had a robust association with the primary outcome with a hazard ratio of 20.6 (95% CI: 10.4-40.8, P < .001) and a negative MEFIB had a high negative predictive value for the primary outcome, 99.1% at 5 years. The 3-year risk of incident hepatocellular carcinoma was 0.35% for MRE <5 kPa, 5.25% for 5 to 8 kPa, and 5.66% for MRE ≥8 kPa, respectively.
CONCLUSION
Liver stiffness assessed by MRE is associated with liver-related events, and the combination of MRE and Fibrosis-4 has excellent negative predictive value for hepatic decompensation. These data have important implications for clinical practice.
背景与目的
磁共振弹性成像（MRE）是肝纤维化的一种准确的生物标志物；然而，有限的数据描述了其与临床结果的关联。我们对非酒精性脂肪性肝病患者进行了一项个体参与者数据汇总荟萃分析，以评估 MRE 上的肝硬度与肝脏相关结局之间的关系。
方法
系统检索确定了 6 个接受基线 MRE 检查并随访肝失代偿、肝细胞癌和死亡的非酒精性脂肪性肝病成年患者队列。使用 Cox 和逻辑回归评估 MRE 上的肝硬度与肝脏相关结局之间的关系，包括定义为需要治疗的静脉曲张、腹水和肝性脑病的复合主要结局。
结果
这项个体参与者数据汇总荟萃分析纳入了 2018 名患者（53%为女性），平均（±标准差）年龄为 57.8（±14）岁，基线时 MRE 分别为 4.15（±2.19）kPa。在 1707 名具有中位（四分位距）3 年（4.2 年）随访的可获得纵向数据的患者中，MRE 为 5 至 8 kPa 的主要结局的风险比为 11.0（95%置信区间[CI]：7.03-17.1，P<.001），MRE≥8 kPa 的风险比为 15.9（95% CI：9.32-27.2，P<.001），而 MRE<5 kPa 的风险比为 15.9（95% CI：9.32-27.2，P<.001）。MEFIB 指数（定义为 MRE≥3.3 kPa 和 Fibrosis-4≥1.6 时为阳性）与主要结局具有很强的关联，风险比为 20.6（95% CI：10.4-40.8，P<.001），MEFIB 阴性具有很高的主要结局阴性预测值，5 年时为 99.1%。MRE<5 kPa 的 3 年肝细胞癌发生率为 0.35%，MRE 为 5 至 8 kPa 的发生率为 5.25%，MRE≥8 kPa 的发生率为 5.66%。
结论
MRE 评估的肝硬度与肝脏相关事件相关，MRE 和 Fibrosis-4 的组合对肝失代偿具有极好的阴性预测值。这些数据对临床实践具有重要意义。
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