摘要
目的应用Meta分析系统评价点剪切波弹性成像(pSWE)与瞬时弹性成像(TE)对非酒精性脂肪肝(NAFLD)患者肝纤维化分期的诊断效能。方法计算机检索万方数据库、中国生物医学文献数据库、中国知网、PubMed、Web of Science、Embase和Cochrane Library数据库,搜索关于pSWE和TE诊断NAFLD患者肝纤维化分期的相关文献,检索时间均为建库至2023年2月1日。由两名研究人员分别独立筛选文献、提取资料并进行偏倚风险评估,采用I2检验探索各研究间的异质性;采用双变量混合效应模型分析并比较两种方法对NAFLD患者肝纤维化分期的诊断效能。结果最终纳入14篇文献,其中应用TE检测8篇,应用pSWE检测3篇,同时应用TE和pSWE检测3篇,TE与pSWE检测失败率比较差异有统计学意义(10.2%vs.0.9%,P<0.05)。Meta分析结果显示,pSWE诊断NAFLD患者≥F2、≥F3、F4期肝纤维化的综合受试者工作特征曲线的曲线下面积分别为0.85[95%CI(可信区间):0.82~0.88]、0.95(95%CI:0.91~0.97)、0.93(95%CI:0.91~0.96);TE的曲线下面积分别为0.83(95%CI:0.82~0.85)、0.90(95%CI:0.89~0.93)、0.94(95%CI:0.91~0.96),两种方法的曲线下面积比较差异均无统计学意义。剔除引起异质性的异常数据后,亚组分析显示,pSWE诊断≥F2、≥F3、F4期肝纤维化的合并阳性似然比和阴性似然比分别为2.69、2.24、2.68和0.07、0.28、0.21,TE的合并阳性似然比和阴性似然比分别为3.22、6.27、11.28和0.31、0.24、0.11。Deeks’漏斗图显示,pSWE和TE诊断肝纤维化不同分期的文献数据均无明显的发表偏倚(均P>0.05)。结论pSWE和TE均可无创、准确地诊断NAFLD患者肝纤维化分期,尤其对≥F3、F4期肝纤维化具有较高的诊断效能。
Objective To systematically evaluate the diagnostic efficacy of point shear wave elastography(pSWE)and transient elastography(TE)for liver fibrosis staging in patients with nonalcoholic fatty liver disease(NAFLD).Methods A computerized search of Wanfang database,China Biomedical Literature Database,China Knowledge Network,PubMed,Web of Science,Embase and Cochrane Library databases was performed to search for literature related to the diagnosis of liver fibrosis staging in NAFLD patients by pSWE and TE.All searches were conducted from the time of database construction to February 1,2023.Two researchers independently screened the literature,extracted the data and assessed the risk of bias,I2 test was used to explore the heterogeneity among studies,and the bivariable mixed effect model was used to analyze and compare the diagnostic efficiency of the two methods in the liver fibrosis stageing in NAFLD patients.Results Fourteen papers were finally included,of which eight applied TE,three applied pSWE,and three applied TE and pSWE,there was a statistically significant difference in failure detection rate between the two methods(10.2%vs.0.9%,P<0.05).The results of the Meta-analysis showed that the comprehensive area under the curve of pSWE in the diagnosis of NAFLD patients with liver fibrosis at≥F2,≥F3 and F4 stages were 0.85[95%confidence interval(CI):0.82~0.88],0.95(95%CI:0.91~0.97),and 0.93(95%CI:0.91~0.96),respectively.While the comprehensive area under the curve of TE were 0.83(95%CI:0.82~0.85),0.90(95%CI:0.89~0.93)and 0.94(95%CI:0.91~0.96),the difference in comprehensive area under the curve between the two methods was not statistically significant.After excluding the outlier data that caused heterogeneity,subgroup analysis showed that the combined positive likelihood ratio and negative likelihood ratio of pSWE in the diagnosis of liver fibrosis at≥F2,≥F3 and F4 stages were 2.69 and 0.07,2.24 and 0.28,2.68 and 0.21,respectively.The combined positive likelihood ratio and negative likelihood ratio of TE wer
作者
李玲子
杨倩
马晓鸣
LI Lingzi;YANG Qian;MA Xiaoming(Department of Ultrasound,Tianjin Dongli Hospital,Tianjin 300399,China)
出处
《临床超声医学杂志》
CSCD
2024年第10期868-876,共9页
Journal of Clinical Ultrasound in Medicine
