切换至 "中华医学电子期刊资源库"

中华消化病与影像杂志(电子版) ›› 2017, Vol. 07 ›› Issue (04) : 172 -182. doi: 10.3877/cma.j.issn.2095-2015.2017.04.007

所属专题: 文献

循证医学

Fibroscan诊断肝纤维化分期的Meta分析
吕婷婷1, 郭钰1, 管宇1, 刘立新2,()   
  1. 1. 030001 太原,山西医科大学第一医院消化科在读硕士研究生
    2. 030001 太原,山西医科大学第一医院科研实验中心;030001 太原,山西医科大学第一医院消化科
  • 收稿日期:2016-07-28 出版日期:2017-08-01
  • 通信作者: 刘立新
  • 基金资助:
    山西省回国留学人员重点科研资助项目(2012-重点4)

A Meta-analysis of Fibroscan for the staging of liver fibrosis

Tingting Lyu1, Yu Guo1, yu Guan1, Lixin Liu2,()   

  1. 1. Postgraduate Student of Department of Gastroenterology, First Hospital of Shanxi Medical University, Taiyuan 030001, China
    2. Experimental Center of Science and Research, First Hospital of Shanxi Medical University, Taiyuan 030001, China; Department of Gastroenterology, First Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2016-07-28 Published:2017-08-01
  • Corresponding author: Lixin Liu
  • About author:
    Corresponding author: Liu Lixin, Email:
引用本文:

吕婷婷, 郭钰, 管宇, 刘立新. Fibroscan诊断肝纤维化分期的Meta分析[J/OL]. 中华消化病与影像杂志(电子版), 2017, 07(04): 172-182.

Tingting Lyu, Yu Guo, yu Guan, Lixin Liu. A Meta-analysis of Fibroscan for the staging of liver fibrosis[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2017, 07(04): 172-182.

目的

通过与肝活检(金标准)对比,系统评价Fibroscan诊断肝纤维化分期的准确性。

方法

计算机检索Pubmed、Embase、中国知网、万方数据知识服务平台及中国生物医学文献数据库中已发表的关于Fibroscan诊断肝纤维化分期的中、英文文献,检索时限为2003年1月至2016年1月,对所选文献进行筛选和评价,应用Stata14.0软件中双变量混合效应模型进行数据分析。

结果

所得文献经过去重、阅读题目、摘要、通读全文逐步剔除后,最终纳入37篇文献,共9167例患者。其中中文文献4篇,英文文献33篇,时间跨度为2005年1月至2015年10月。结果显示:(1)FibroScan诊断轻微肝纤维化(F≥1)的合并灵敏度(Sen)、特异度(Sep)、阳性似然比(PPV)、阴性似然比(NPV)、诊断比值比(OR)及SROC曲线下面积(AUC)分别为0.76、0.80、3.9、0.30、13、0.85;(2)FibroScan诊断明显肝纤维化(F≥2)的Sen、Sep、PPV、NPV、OR及AUC分别为0.77、0.84、4.7、0.28、17、0.88;(3)FibroScan诊断严重肝纤维化(F≥3)的Sen、Sep、PPV、NPV、OR及AUC分别为0.84、0.87、6.3、0.19、34、0.92;(4)FibroScan诊断早期肝硬化(F≥4)的Sen、Sep、PPV、NPV、OR及AUC分别0.89、0.89、8.2、0.12、67、0.95。

结论

Fibroscan对肝纤维化分期、尤其是对严重肝纤维化及早期肝硬化的诊断准确性较高。

Objective

To evaluate the accuracy of Fibroscan in diagnosis of liver fibrosis stage comparing with liver biopsy(gold standard).

Methods

Chinese and English literatures related Fibroscan diagnosis of liver fibrosis stage between January 2003 and January 2016 published in Pubmed, EMBase, China National Knowledge Infrastructure(CNKI), Wanfang Data Knowledge Service Platform and Chinese Biomedical Literature Database were evaluated and selected.Stata 14.0 software bivariate mixed effects model was used to conduct data analysis.

Results

Thirty-seven studies which include 9 167 subjects were finally collected by deleting duplicate documents, gradually reading the title, abstract and full text.Among them 4 were Chinese studies, 33 were English studies.The time span was from January 2005 to October 2015.The results showed that the sensitivity(Sen), specificity(Sep), positive likelihood ratio(PPV), negative likelihood ratio(NPV), diagnostic odds ratio(OR)and SROC area under the curve(AUC)for slight(F≥1), obvious(F≥2), severe(F≥3)liver fibrosis and early cirrhosis(F≥4)were 0.76, 0.80, 3.9, 0.30, 13, 0.85 and 0.77, 0.84, 4.7, 0.28, 17, 0.88 and 0.84, 0.87, 6.3, 0.19, 34, 0.92 and 0.89, 0.89, 8.2, 0.12, 67, 0.95.

Conclusion

Fibroscan is highly accurate in staging of liver fibrosis, especially in the diagnosis of severe hepatic fibrosis and early cirrhosis.

图1 PubMed检索策略
图2 文献筛选流程图
图3 文献质量评价图
表1 纳入文献的基本特征
作者 年份 病因 国家 总例数/男性例数 间隔时间 平均年龄(岁) BMI(kg/m2) ALT(U/L)
Ziol 2005 HCV 法国 251/155 6月内 47.5±13.0
CASTéRA 2005 HCV 法国 183/104 同一天 22.9
Chang12 2008 MIXED 新加坡 120/- 1天 40.1
Marcelli20 2008 HBV 法国 173/115 29天 40.1±12.8 28.0 75.0
Obara 2008 MIXED 日本 114/55 6个月内
Khac13 2008 ALD 法国 103/76 同一天 52.6±9.6 27.4 116.0
Nahon 2008 ALD 法国 147/112 同一天 54.4±8.9 24.0 93.0
Chan 2009 HBV 中国 161/122 4周 45.0±11.0
Lupsor14 2009 HCV 罗马尼亚 112/- 同一天 49.0±12.3 25.2 65.0
Wang29 2009 HBV/HCV 中国 320/199 同一天 50.8±11.9 23.5
Sporea21 2010 HBV/HCV 罗马尼亚 457/- 同时 23.2 47.6
Wong15 2010 NAFLD 中国 246/135 1周 26.1 ?
Gaia19 2010 MIXED 意大利 219/174 4个月 70.8
Ichino30 2010 HCV 日本 165/92 1周 53.2±12.6 24.5
Myers7 2010 MIXED 加拿大 251/166 6月内
?瘙塁irli8 2010 HCV 罗马尼亚 150/48 同时 50.4±10.3 26 77.2
Zhu22 2011 HBV 中国 175/137 24 h 36.5±9.4
Sporea9 2011 HCV 罗马尼亚 197/78 同时 50.0±9.8 23.9
Liu23 2011 HCV 中国 284/168 2周 23.4 62.9
Lesmana16 2011 HBV 印尼 117/63 同一天 40.7±11.0 26.1 80.2
Rizzo27 2011 HCV 意大利 139/83 6月内 55.0± 12.0 ?
陈学兵10 2011 HBV 中国 213/167 一周内 27.1 86.2
Kumar 2012 NAFLD 印度 120/90 隔一天 25.7
Kim 2012 HBV 韩国 170/102 1天 45.3±15.1 20.0 87.6
杨惠安 2015 HBV 中国 105/67 同一天 35.8±12.6
Ferraioli 2013 MIXED 意大利 246/171 同一天 24.2
Platon18 2013 HCV 罗马尼亚 1202/465 1天 50.6±10.8
Cassinotto 2014 MIXED 法国 332/- 2周之内 24.1
Sharma24 2014 MIXED 印第安 175/117 同时 41.0±13.0 95.0
Wong11 2014 HBV 中国 238/190 同一天 50.0±11.0 26.7
Afdha25 2014 HBV/HCV 美国 188/130 25.6 85.7
曹欣 2014 HBV 中国 162/121 34.7±11.0 24.4 56.9
Zeng26 2015 HBV 中国 262/198 2天 35.8±10.9 23.64 156.9
Meng27 2015 HBV 中国 166/78 同时 37.0±9.0 122.8
王春研28 2015 HBV 中国 142/96 同期 38.1±11.1 24.6
Seo19 2015 HBV/HCV 韩国 916/531 285.9
Crisan17 2012 HCV 罗马尼亚 446/170 25.0
表2 双变量混合效应模型统计结果
表3 阈值效应、异质性分析及发表偏倚检测结果
表4 Meta回归结果
图4 4A Fibroscan诊断F≥1组的SROC曲线图;4B Fibroscan诊断F≥2组的SROC曲线图;4C Fibroscan诊断F≥3组的SROC曲线图;4D Fibroscan诊断F≥4组的SROC曲线图
图5A Fibroscan诊断F≥1组的合并灵敏度、特异度森林图
图5B Fibroscan诊断F≥2组的合并灵敏度、特异度森林图
图5C Fibroscan诊断F≥3组的合并灵敏度、特异度森林图
图5D Fibroscan诊断F≥4组的合并灵敏度、特异度森林图
1
Kose S, Ersan G, Tatar B, et al.Evaluation of Percutaneous Liver Biopsy Complications in Patients with Chronic Viral Hepatitis[J]. Eurasian J Med, 2015, 47(3): 161-164.
2
Kaswala DH, Lai M, Afdhal NH.Fibrosis Assessment in Nonalcoholic Fatty Liver Disease(NAFLD)in 2016[J]. Dig Dis Sci, 2016, 61(5): 1356-1364.
3
欧晓娟,王晓明,吴晓宁,等.FibroTouch与FibroScan在慢性乙型肝炎患者肝纤维化评估中的比较[J].中华肝脏病杂志,2015,23(2):103-106.
4
曲加祥,刘立新.瞬时弹性超声与多参数模型联合诊断肝纤维化、肝硬化的临床研究[J/CD].中华临床医师杂志(电子版),2012,6(20):6260-6264.
5
Pavlov CS, Casazza G, Nikolova D, et al.Systematic review with meta-analysis: diagnostic accuracy of transient elastography for staging of fibrosis in people with alcoholic liver disease[J]. Aliment Pharmacol Ther, 2016, 43(5): 575-585.
6
Whiting PF, Rutjes AW, Westwood ME, et al.QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies[J]. Ann Intern Med, 2011, 155(8): 529-536.
7
Myers RP, Elkashab M, Ma M, et al.Transient elastography for the noninvasive assessment of liver fibrosis: a multicentre Canadian study[J]. Can J Gastroenterol, 2010, 24(11): 661-670.
8
Sirli R, Sporea I, Bota S, et al.A comparative study of non-invasive methods for fibrosis assessment in chronic HCV infection[J]. Hepat Mon, 2010, 10(2): 88-94.
9
Sporea I, Ş irli R, Popescu A, et al.Is it better to use two elastographic methods for liver fibrosis assessment? [J]. World J Gastroenterol, 2011, 17(33): 3824-3829.
10
陈学兵,朱霞,陈立宇,等.丙氨酸转氨酶对FibroScan诊断慢性乙型肝炎肝纤维化分期的影响[J].中华肝脏病杂志,2011,19(4):286-290.
11
Wong GL, Chan HL, Choi PC, et al.Non-invasive algorithm of enhanced liver fibrosis and liver stiffness measurement with transient elastography for advanced liver fibrosis in chronic hepatitis B[J]. Aliment Pharmacol Ther, 2014, 39(2): 197-208.
12
Chang PE, Lui HF, Chau YP, et al.Prospective evaluation of transient elastography for the diagnosis of hepatic fibrosis in Asians: comparison with liver biopsy and aspartate transaminase platelet ratio index[J]. Aliment Pharmacol Ther, 2008, 28(1): 51-61.
13
Nguyen-Khac E, Chatelain D, Tramier B, et al.Assessment of asymptomatic liver fibrosis in alcoholic patients using fibroscan: prospective comparison with seven non-invasive laboratory tests[J]. Aliment Pharmacol Ther, 2008, 28(10): 1188-1198.
14
Lupsor M, Badea R, Stefanescu H, et al.Performance of a new elastographic method(ARFI technology)compared to unidimensional transient elastography in the noninvasive assessment of chronic hepatitis C. Preliminary results[J]. J Gastrointestin Liver Dis, 2009, 18(3): 303-310.
15
Wong VW, Vergniol J, Wong GL, et al.Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease[J]. Hepatology, 2010, 51(2): 454-462.
16
Lesmana CR, Salim S, Hasan I, et al.Diagnostic accuracy of transient elastography(FibroScan)versus the aspartate transaminase to platelet ratio index in assessing liver fibrosis in chronic hepatitis B: the role in primary care setting[J]. J Clin Pathol, 2011, 64(10): 916-920.
17
Crisan D, Radu C, Lupsor M, et al.Two or more synchronous combination of noninvasive tests to increase accuracy of liver fibrosis assessement in chronic hepatitis C;results from a cohort of 446 patients[J]. Hepat Mon, 2012, 12(3): 177-184.
18
Lupsor Platon M, Stefanescu H, Feier D, et al.Performance of unidimensional transient elastography in staging chronic hepatitis C. Results from a cohort of 1, 202 biopsied patients from one single center[J]. J Gastrointestin Liver Dis, 2013, 22(2): 157-166.
19
Seo YS, Kim MY, Kim SU.Accuracy of transient elastography in assessing liver fibrosis in chronic viral hepatitis: A multicentre, retrospective study[J]. Liver Int, 2015, 35(10): 2246-2255.
20
Marcellin P, Ziol M, Bedossa P, et al.Non-invasive assessment of liver fibrosis by stiffness measurement in patients with chronic hepatitis B[J]. Liver Int, 2009, 29(2): 242-247.
21
Sporea I, Sirli R, Deleanu A, et al.Liver stiffness measurements in patients with HBV vs HCV chronic hepatitis: a comparative study[J]. World J Gastroenterol, 2010, 16(38): 4832-4837.
22
Zhu X, Wang LC, Chen EQ, et al.Prospective evaluation of FibroScan for the diagnosis of hepatic fibrosis compared with liver biopsy/AST platelet ratio index and FIB-4 in patients with chronic HBV infection[J]. Dig Dis Sci, 2011, 56(9): 2742-2749.
23
Liu CH, Liang CC, Huang KW, et al.Transient elastography to assess hepatic fibrosis in hemodialysis chronic hepatitis C patients[J]. Clin J Am Soc Nephrol, 2011, 6(5): 1057-1065.
24
Sharma P, Dhawan S, Bansal R, et al.Usefulness of transient elastography by FibroScan for the evaluation of liver fibrosis[J]. Indian J Gastroenterol, 2014, 33(5): 445-451.
25
Afdha NH, Bacon BR, Patel K, et al.Accuracy of fibroscan, compared with histology, in analysis of liver fibrosis in patients with hepatitis B or C: a United States multicenter study[J]. Clin Gastroenterol Hepatol, 2015, 13(4): 772-779, e1-3.
26
Zeng X, Xu C, He D, et al.Performance of several simple, noninvasive models for assessing significant liver fibrosis in patients with chronic hepatitis B[J]. Croat Med J, 2015, 56(3): 272-279.
27
Meng F, Zheng Y, Zhang Q, et al.Noninvasive evaluation of liver fibrosis using real-time tissue elastography and transient elastography(FibroScan)[J]. J Ultrasound Med, 2015, 34(3): 403-410.
28
王春研,程晓静,孟超,等.Fibrotest对慢性乙型肝炎肝纤维化程度诊断效能的评估价值[J].中华肝脏病杂志,2015,23(10):738-741.
29
Wang JH, Changchien CS, Hung CH, et al.FibroScan and ultrasonography in the prediction of hepatic fibrosis in patients with chronic viral hepatitis[J]. J Gastroenterol, 2009, 44(5): 439-446.
30
Ichino N, Osakabe K, Nishikawa T, et al.A new index for non-invasive assessment of liver fibrosis[J]. World J Gastroenterol, 2010, 16(38): 4809-4816.
31
Chu H, Cole SR.Bivariate meta-analysis of sensitivity and specificity with sparse data: a generalized linear mixed model approach[J]. J Clin Epidemiol, 2006, 59(12): 1331-1332.
32
瞬时弹性成像技术(TE)临床应用共识专家委员会.瞬时弹性成像技术(TE)临床应用专家共识(2015年)[J/CD].中国肝脏病杂志(电子版),2015,7(2):12-18.
[1] 蚁淳, 袁冬生, 熊学军. 系统免疫炎症指数与骨密度降低和骨质疏松的关联[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 609-617.
[2] 李志文, 李远志, 李华, 方志远. 糖皮质激素治疗膝骨关节炎疗效的网状Meta分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 484-496.
[3] 吴姗姗, 潘裕民, 刘晋, 张劲松, 乔莉. 睡眠呼吸暂停综合征患者静脉血栓栓塞症发生率的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 312-317.
[4] 程鹏, 杨道鸿, 邓文君, 钟宇琼, 胡晓雪, 黄小银, 周道扬. 纤维蛋白原治疗创伤性凝血病有效性和安全性的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(03): 225-231.
[5] 沈皓, 张驰, 韩旻轩, 陆晓庆, 周愉, 周莉丽. 骨皮质切开术对正畸治疗牙根吸收影响的Meta分析[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(03): 175-184.
[6] 郭仁凯, 武慧铭, 李辉宇. 机器人辅助全系膜切除术治疗右半结肠癌有效性和安全性的Meta分析及试验序贯分析[J/OL]. 中华普通外科学文献(电子版), 2024, 18(03): 234-240.
[7] 朱俊佳, 孙琦, 徐文龙, 陆天宇, 冯强, 储涛, 邢春根, 高春冬, 俞一峰, 赵振国. 永久性结肠造口预防性补片置入对预防造口旁疝价值的Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 336-342.
[8] 王招荐, 曹桢, 郭小双, 靳小雷, 刘子文. 加速康复外科理念应用于腹壁重建手术的系统评价及Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 343-350.
[9] 高瑞, 康迪斯, 秦蘅, 胡月明, 初同伟, 代丽. 加速康复管理改善膝关节置换术后肺部感染并发症和疗效的Meta分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(02): 234-237.
[10] 马振威, 宋润夫, 王兵. ERCP胆道内支架与骑跨十二指肠乳头支架置入治疗不可切除肝门部胆管癌疗效的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 807-812.
[11] 龚财芳, 赵俊宇, 游川. 围手术期肠内营养在肝癌肝切除患者中有效性及安全性的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 551-556.
[12] 郁凯, 曾保起, 杨剑, 杨杰, 张殿英, 孙凤. 全关节镜与切开手术治疗肩袖撕裂疗效比较的系统综述与Meta分析[J/OL]. 中华肩肘外科电子杂志, 2024, 12(03): 238-245.
[13] 王芳, 刘达, 左智炜, 盛金平, 陈庭进, 蒋锐. 定量CT与双能X线骨密度仪对骨质疏松诊断效能比较的Meta分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 363-371.
[14] 李浩, 陈棋帅, 费发珠, 张宁伟, 李元东, 王硕晨, 任宾. 慢性肝病肝纤维化无创诊断的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 863-867.
[15] 周倩妹, 王宪娥, 徐筱, 老慧琳, 赵欣悦, 胡菁颖. 多元化系统护理对老年人群牙周健康指标影响的系统评价[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 500-506.
阅读次数
全文


摘要