Kumar Ashish, Maruyama Hitoshi, Arora Anil, Sharma Praveen, Anikhindi Shrihari Anil, Bansal Naresh, Kumar Mandhir, Ranjan Piyush, Sachdeva Munish, Khare Shivam
Institute of Liver, Gastroenterology, & Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India.
Department of Gastroenterology, Juntendo University, Tokyo, Japan.
J Med Ultrason (2001). 2022 Jul;49(3):333-346. doi: 10.1007/s10396-022-01239-x. Epub 2022 Jul 25.
Liver stiffness measurement using transient elastography (TE-LSM) is a promising noninvasive alternative to hepatic venous pressure gradient (HVPG) for diagnosing clinically significant portal hypertension (CSPH). However, previous studies have yielded conflicting results. We evaluated the correlation between TE-LSM and HVPG and the performance of TE-LSM in diagnosing CSPH (HVPG ≥ 10 mmHg).
We conducted a systematic review and meta-analysis by searching PubMed and Scopus databases for relevant literature evaluating the clinical usefulness of TE for diagnosing CSPH in patients with chronic liver disease.
Twenty-six studies (4337 patients with valid TE and HVPG) met our inclusion criteria. The median correlation coefficient of TE with HVPG was 0.70 (range 0.36-0.86). The weighted mean of optimal cut-off of liver stiffness value for diagnosing CSPH was 22.8 kPa (95% CI 22.7-23.0 kPa). The summary sensitivity and specificity were 79% (95% CI 74-84%) and 88% (95% CI 84-91%), respectively. The area under the hierarchical summary receiver operating characteristic (HSROC) curve was 0.91 (95% CI 0.88-0.93) according to the bivariate model. One limitation of the study was significant heterogeneity in the results of summary sensitivity and specificity (I 83 and 74%, respectively). The heterogeneity could be explained by the variable liver stiffness cut-offs used in studies. The meta-regression plot revealed that as the optimal cut-off increased, the sensitivity decreased, the specificity increased, and vice versa.
Liver stiffness measurement using TE correlates well with HVPG, and a liver stiffness cut-off value of 22.8 kPa shows a high accuracy for diagnosing CSPH. Thus, use of TE should be integrated into clinical practice for noninvasive diagnosis of CSPH.
使用瞬时弹性成像技术测量肝脏硬度（TE-LSM）是一种有前景的非侵入性方法，可替代肝静脉压力梯度（HVPG）用于诊断临床显著性门静脉高压（CSPH）。然而，既往研究结果相互矛盾。我们评估了TE-LSM与HVPG之间的相关性以及TE-LSM在诊断CSPH（HVPG≥10 mmHg）中的性能。
通过检索PubMed和Scopus数据库，对评估TE在诊断慢性肝病患者CSPH方面临床实用性的相关文献进行系统评价和荟萃分析。
26项研究（4337例有有效TE和HVPG数据的患者）符合纳入标准。TE与HVPG的中位相关系数为0.70（范围0.36 - 0.86）。诊断CSPH的肝脏硬度值最佳截断值的加权平均值为22.8 kPa（95% CI 22.7 - 23.0 kPa）。汇总敏感性和特异性分别为79%（95% CI 74 - 84%）和88%（95% CI 84 - 91%）。根据双变量模型，分层汇总受试者工作特征（HSROC）曲线下面积为0.91（95% CI 0.88 - 0.93）。该研究的一个局限性是汇总敏感性和特异性结果存在显著异质性（分别为I² 83%和74%）。这种异质性可以通过研究中使用的不同肝脏硬度截断值来解释。荟萃回归图显示，随着最佳截断值增加，敏感性降低，特异性增加，反之亦然。
使用TE测量肝脏硬度与HVPG相关性良好，肝脏硬度截断值22.8 kPa对诊断CSPH具有较高准确性。因此，应将TE纳入CSPH的无创诊断临床实践中。
