振动控制瞬时弹性成像和磁共振弹性成像在诊断非酒精性脂肪性肝病患者进展性肝纤维化中的最佳截断值：系统评价和荟萃分析。

Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis.

机构信息

Department of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.

出版信息

Clin Mol Hepatol. 2024 Sep;30(Suppl):S117-S133. doi: 10.3350/cmh.2024.0392. Epub 2024 Aug 21.

BACKGROUND/AIMS: Opinions differ regarding vibration-controlled transient elastography and magnetic resonance elastography (VCTE/MRE) cut-offs for diagnosing advanced fibrosis (AF) in patients with non-alcoholic fatty liver disease (NAFLD). We investigated the diagnostic performance and optimal cut-off values of VCTE and MRE for diagnosing AF.

METHODS

Literature databases, including Medline, EMBASE, Cochrane Library, and KoreaMed, were used to identify relevant studies published up to June 13, 2023. We selected studies evaluating VCTE and MRE regarding the degree of liver fibrosis using liver biopsy as the reference. The sensitivity, specificity, and area under receiver operating characteristics curves (AUCs) of the pooled data for VCTE and MRE for each fibrosis stage and optimal cut-offs for AF were investigated.

RESULTS

A total of 19,199 patients from 63 studies using VCTE showed diagnostic AUC of 0.83 (95% confidence interval: 0.80-0.86), 0.83 (0.80-0.86), 0.87 (0.84-0.90), and 0.94 (0.91-0.96) for ≥F1, ≥F2, ≥F3, and F4 stages, respectively. Similarly, 1,484 patients from 14 studies using MRE showed diagnostic AUC of 0.89 (0.86-0.92), 0.92 (0.89-0.94), 0.89 (0.86-0.92), and 0.94 (0.91-0.96) for ≥F1, ≥F2, ≥F3, and F4 stages, respectively. The diagnostic AUC for AF using VCTE was highest at 0.90 with a cut-off of 7.1-7.9 kPa, and that of MRE was highest at 0.94 with a cut-off of 3.62-3.8 kPa.

CONCLUSION

VCTE (7.1-7.9 kPa) and MRE (3.62-3.8 kPa) with the suggested cut-offs showed favorable accuracy for diagnosing AF in patients with NAFLD. This result will serve as a basis for clinical guidelines for non-invasive tests and differential diagnosis of AF.

背景/目的：对于诊断非酒精性脂肪性肝病（NAFLD）患者的晚期纤维化（AF），振动控制瞬时弹性成像（VCTE）和磁共振弹性成像（MRE）的截断值存在不同意见。我们研究了 VCTE 和 MRE 诊断 AF 的诊断性能和最佳截断值。

方法

使用包括 Medline、EMBASE、Cochrane 图书馆和 KoreaMed 在内的文献数据库，检索截至 2023 年 6 月 13 日发表的相关研究。我们选择了使用肝活检评估 VCTE 和 MRE 对肝纤维化程度的研究。研究了 VCTE 和 MRE 对每个纤维化阶段的汇总数据的敏感性、特异性和受试者工作特征曲线下面积（AUCs），以及 AF 的最佳截断值。

结果

使用 VCTE 的 63 项研究中的 19199 名患者显示，VCTE 对≥F1、≥F2、≥F3 和 F4 期的诊断 AUC 分别为 0.83（95%置信区间：0.80-0.86）、0.83（0.80-0.86）、0.87（0.84-0.90）和 0.94（0.91-0.96）。同样，使用 MRE 的 14 项研究中的 1484 名患者显示，MRE 对≥F1、≥F2、≥F3 和 F4 期的诊断 AUC 分别为 0.89（0.86-0.92）、0.92（0.89-0.94）、0.89（0.86-0.92）和 0.94（0.91-0.96）。VCTE 诊断 AF 的最佳 AUC 为 0.90，截断值为 7.1-7.9 kPa，MRE 诊断 AF 的最佳 AUC 为 0.94，截断值为 3.62-3.8 kPa。