Department of Gastroenterology and Hepatology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
Department of Internal Medicine, Institute of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Clin Mol Hepatol. 2024 Sep;30(Suppl):S134-S146. doi: 10.3350/cmh.2024.0586. Epub 2024 Aug 21.
BACKGROUND/AIMS: The assessment of liver fibrosis is crucial for managing autoimmune liver diseases such as primary biliary cholangitis (PBC), autoimmune hepatitis (AIH), and primary sclerosing cholangitis (PSC). However, data on the efficacy of noninvasive tests for these diseases are limited. This meta-analysis evaluated the diagnostic accuracy of vibration-controlled transient elastography (VCTE) for staging fibrosis in patients with autoimmune liver disease.
Searches were conducted in PubMed, Embase, CINAHL, Web of Science, and Cochrane Library databases to assess the diagnostic accuracy of VCTE against histology as the reference standard in adult patients with autoimmune liver disease. The summary area under the curve (sAUC) and diagnostic odds ratio were calculated for significant fibrosis (SF), advanced fibrosis (AF), and cirrhosis, according to liver biopsy.
Fourteen articles were included, comprising 559 PBC patients from six studies, 388 AIH patients from five studies, and 151 PSC patients from three studies. VCTE demonstrated good performance for fibrosis staging in PBC, AIH, and PSC. In PBC, sAUCs of VCTE were 0.87, 0.89, and 0.99 for staging SF, AF, and cirrhosis, respectively. In AIH, the sAUCs were 0.88, 0.88, and 0.92, respectively, while in PSC, they were 0.88, 0.95, and 0.92, respectively. The cutoff values for AF were 7.5-17.9 kPa in PBC, 8.18-12.1 kPa in AIH, and 9.6 kPa in PSC.
VCTE shows high diagnostic accuracy for staging liver fibrosis in patients with autoimmune liver diseases. This non-invasive method serves as a valuable tool for the evaluation and monitoring of fibrosis in these lifelong diseases.
背景/目的：评估肝纤维化对于原发性胆汁性胆管炎（PBC）、自身免疫性肝炎（AIH）和原发性硬化性胆管炎（PSC）等自身免疫性肝病的管理至关重要。然而，关于这些疾病的非侵入性检测方法的疗效数据有限。本荟萃分析评估了振动控制瞬时弹性成像（VCTE）在评估自身免疫性肝病患者纤维化分期中的诊断准确性。
在 PubMed、Embase、CINAHL、Web of Science 和 Cochrane Library 数据库中进行检索，以评估 VCTE 对自身免疫性肝病成人患者的组织学参考标准的诊断准确性。根据肝活检，计算显著纤维化（SF）、进展性纤维化（AF）和肝硬化的汇总曲线下面积（sAUC）和诊断比值比。
共纳入 14 篇文章，包括 6 项研究的 559 例 PBC 患者、5 项研究的 388 例 AIH 患者和 3 项研究的 151 例 PSC 患者。VCTE 显示在 PBC、AIH 和 PSC 中进行纤维化分期的性能良好。在 PBC 中，VCTE 对 SF、AF 和肝硬化的 sAUC 分别为 0.87、0.89 和 0.99。在 AIH 中，sAUC 分别为 0.88、0.88 和 0.92，而在 PSC 中，sAUC 分别为 0.88、0.95 和 0.92。PBC 中 AF 的截断值为 7.5-17.9 kPa，AIH 中为 8.18-12.1 kPa，PSC 中为 9.6 kPa。
VCTE 对自身免疫性肝病患者的肝纤维化分期具有较高的诊断准确性。这种非侵入性方法是评估和监测这些终身疾病纤维化的有价值工具。
