二维剪切波弹性成像评估慢性晚期肝病患者高危静脉曲张的脾脏硬度：系统评价和荟萃分析。

Evaluation of spleen stiffness by 2D shear wave elastography for ruling out high risk varices in patients with chronic advanced liver disease. A systematic review and meta-analysis.

机构信息

Academic Department of Gastroenterology, Medical School of National & Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece.

出版信息

Eur J Radiol. 2024 Jun;175:111475. doi: 10.1016/j.ejrad.2024.111475. Epub 2024 Apr 18.

DOI:10.1016/j.ejrad.2024.111475

PMID:38643527

Abstract

OBJECTIVES

To systematically review the accuracy of spleen stiffness measurement (SSM) by 2D- Shear Wave Elastography (2D-SWE) in predicting high risk for bleeding varices (HRV) in cirrhotic patients.

METHODS

PubMed, Embase, Web of Science, Medline, Cochrane, and Google Scholar databases were searched up to 31/05/2023 for all human studies using 2D-SWE to estimate SSM and endoscopy to detect HRV. Meta-analysis was performed using a generalized linear mixed model. Publication bias was evaluated using the funnel plot asymmetry test. The Area Under the Summarized Receiver Operating Characteristic curve (AUSROC) was estimated using the "mada" package.

RESULTS

A total of 13 studies and 1970 patients were included. Of them, 27.8 % had HRV. The pooled sensitivity and polled specificity of SSM in detecting HRV were 90 % (95 %CI:87-92 %) and 68 % (95 %CI:58-77 %), respectively, with an AUSROC at 0.86 (95 %CI:0.82-0.90). The median cutoff value of SSM in detecting HRV was 34.2 kPa. In studies including exclusively HBV cirrhotic patients, SSM's polled sensitivity and specificity in predicting HRV was 88 % (95 %CI:82-92 %) and 73 % (95 %CI:68-78 %), respectively. The AUSROC was 0.84 (95 %CI:0.81-0.87). The number of repeated measurements per patient (<5 or ≥ 5) did not affect the method's capability. Using Aixplorer to evaluate SSM had a higher sensitivity in ruling out HRV than other 2D-SWE devices.

CONCLUSIONS

Our meta-analysis supports that SSM by 2D-SWE has a good diagnostic performance for ruling out HRV in cirrhosis.

摘要

目的

系统评价二维剪切波弹性成像（2D-SWE）测量脾脏硬度（SSM）预测肝硬化患者高危出血静脉曲张（HRV）的准确性。

方法

检索PubMed、Embase、Web of Science、Medline、Cochrane 和 Google Scholar 数据库，截至 2023 年 5 月 31 日，收集所有使用 2D-SWE 估计 SSM 和内镜检测 HRV 的人体研究。使用广义线性混合模型进行荟萃分析。使用漏斗图不对称检验评估发表偏倚。使用“mada”包估计汇总受试者工作特征曲线下面积（AUSROC）。

结果

共纳入 13 项研究和 1970 例患者，其中 27.8%有 HRV。SSM 检测 HRV 的 pooled 敏感性和 pooled 特异性分别为 90%（95%CI：87-92%）和 68%（95%CI：58-77%），AUSROC 为 0.86（95%CI：0.82-0.90）。SSM 检测 HRV 的中位数截断值为 34.2 kPa。在仅包括乙型肝炎肝硬化患者的研究中，SSM 预测 HRV 的 pooled 敏感性和特异性分别为 88%（95%CI：82-92%）和 73%（95%CI：68-78%），AUSROC 为 0.84（95%CI：0.81-0.87）。每位患者的重复测量次数（<5 次或≥5 次）不影响该方法的能力。使用 Aixplorer 评估 SSM 对排除 HRV 的敏感性高于其他 2D-SWE 设备。