Sun Yuxin, Hu Die, Yu Mingkun, Liang Shi-Bing, Zheng Youyou, Wang Xin, Tong Guangdong
Shenzhen Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Shenzhen, People's Republic of China.
Department of Oncology, Binzhou Hospital of Traditional Chinese Medicine, Binzhou, People's Republic of China.
Clin Epidemiol. 2025 Jan 28;17:53-71. doi: 10.2147/CLEP.S501445. eCollection 2025.
In recent decades, numerous non-invasive tests (NITs) for diagnosing nonalcoholic fatty liver disease (NAFLD) have been developed, however, a comprehensive comparison of their relative diagnostic accuracies is lacking. We aimed to assess and compare the diagnostic accuracy of various NITs for NAFLD using network meta-analysis (NMA).
We conducted a systematic search in seven databases up to April 2024 to identify studies evaluating the diagnostic values of NITs, with liver biopsy as the gold standard. The participants included patients with suspected or confirmed NAFLD, irrespective of age, sex, ethnicity. Statistical analysis was conducted using R 4.0.3 for Bayesian NMA and STATA 17.0 for pairwise meta-analysis. Sensitivity, specificity, diagnostic odds ratio (DOR), area under the receiver operating characteristic curve (AUC), and superiority index were calculated. Bayesian calculations were performed using the Rstan package, specifying parameters like MCMC chain count, iteration count, and operational cycles. The methodological quality of included studies was assessed using the QUADAS-2 tool.
Out of 15,877 studies, 180 were included in the quantitative synthesis, and 102 were used in head-to-head meta-analyses. For diagnosing steatosis stage 1, Hydrogen Magnetic Resonance Spectroscopy (H-MRS, DOR 15,745,657.6, 95% CI 17.2-1,014,063.59) proved to be the most accurate. For significant fibrosis, HRI leading (DOR 80.94, 95% CI 6.46-391.41), For advanced fibrosis, CK-18 showed the highest performance (DOR 102654.16, 95% CI 1.6-134,059.8). For high-risk NASH, Real-Time Elastography showing the highest performance (DOR 18.1, 95% CI 0.7-96.33). Meta-regression analyses suggested that variability in the diagnostic accuracy of NITs for NAFLD may result from differences in study design, thresholds, populations, and performance indicators.
We conducted a network meta-analysis to rank the accuracy of these tests. While some results are promising, not all NITs demonstrate substantial accuracy, highlighting the need for validation with larger datasets. Future research should concentrate on studying the thresholds of NITs and enhancing the clarity of methodological reporting.
近几十年来，已开发出众多用于诊断非酒精性脂肪性肝病（NAFLD）的非侵入性检测方法（NITs），然而，缺乏对它们相对诊断准确性的全面比较。我们旨在使用网络荟萃分析（NMA）评估和比较各种NITs对NAFLD的诊断准确性。
我们在截至2024年4月的七个数据库中进行了系统检索，以识别评估NITs诊断价值的研究，以肝活检作为金标准。参与者包括疑似或确诊为NAFLD的患者，不分年龄、性别、种族。使用R 4.0.3进行贝叶斯NMA统计分析，使用STATA 17.0进行成对荟萃分析。计算敏感性、特异性、诊断比值比（DOR）、受试者操作特征曲线下面积（AUC）和优势指数。使用Rstan软件包进行贝叶斯计算，指定参数如MCMC链数、迭代次数和运行周期。使用QUADAS - 2工具评估纳入研究的方法学质量。
在15877项研究中，180项纳入定量合成，102项用于直接比较的荟萃分析。对于诊断1期脂肪变性，氢磁共振波谱（H - MRS，DOR 15745657.6，95% CI 17.2 - 1014063.59）被证明是最准确的。对于显著纤维化，HRI领先（DOR 80.94，95% CI 6.46 - 391.41）；对于晚期纤维化，CK - 18表现最佳（DOR 102654.16，95% CI 1.6 - 134059.8）。对于高风险非酒精性脂肪性肝炎，实时弹性成像表现最佳（DOR 18.1，95% CI 0.7 - 96.33）。荟萃回归分析表明，NITs对NAFLD诊断准确性的差异可能源于研究设计、阈值、人群和性能指标的不同。
我们进行了网络荟萃分析以对这些检测方法的准确性进行排名。虽然一些结果很有前景，但并非所有NITs都显示出很高的准确性，这突出了用更大数据集进行验证的必要性。未来的研究应集中于研究NITs的阈值并提高方法学报告的清晰度。
