RTE对病毒性肝炎肝纤维化分级诊断的meta分析  

Diagnostic accuracy of hepatic fibrosis stage by Real-Time Tissue Elastography with viral hepatitis:a meta-analysis

作　　者：刘刚[1] 李孟天 丰锦春 张士杰[2] 吴向未[2] 孙红[2] 彭心宇[2] 

机构地区：[1]石河子大学医学院,832000 [2]石河子大学医学院第一附属医院肝胆外科,832000

出　　处：《中华灾害救援医学》2016年第6期310-314,325,共6页Chinese Journal of Disaster Medicine

基　　金：国家科技援疆专项(2014AB051)

摘　　要：目的运用meta分析方法评价实时组织弹性成像技术(real-time tissue elastography,RTE)对病毒性肝炎肝纤维化分级诊断的准确性。方法系统检索国内外多个文献数据库,收集RTE评价病毒性肝纤维化的相关文献,根据QUADAS-2量表对纳入文献行质量评价;根据METAVIR分级法,选取F≥1,2,3,4级作为肝纤维化的截断值,采用双变量随机效应模型,合并敏感度和特异度,绘制SROC曲线,计算曲线下面积,漏斗图观察发表偏倚情况。结果共纳入17篇RTE诊断文献,总计2238例受试者,中位数年龄44.60岁,男性占比55.60%;各组别敏感度的异质性卡方检验结果如下:F≥2组,χ2=24.38,P=0.0589;F≥3组,χ2=69.53,P<0.001;F≥4组,χ2=35.59,P=0.0003。各组别特异度异质性的卡方检验结果如下:F≥2组,χ2=47.76,P<0.001;F≥3组,χ2=83.42,P<0.001;F≥4组,χ2=42.11,P=0.0001。合并敏感度和合并特异度分别为:F≥2:0.79、0.76;F≥3:0.72、0.73;F≥4:0.76、0.82;各分级相对应的综合受试者工作特征曲线下面积(AUC)分别:0.866、0.859、0.864。结论 RTE对慢性肝炎肝纤维化分级诊断具有一定价值,但尚不能取代肝穿刺活检技术。Objective To evaluate the overall accuracy of real-time tissue elastography（RTE） for the staging of liver fibrosis with viral hepatitis by meta-analysis. Methods Systematic retrieval of domestic and foreign literature database for both original Chinese and English-language articles about RTE for the staging of liver fibrosis with viral hepatitis. The quality of studies included in this study were assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review（QUADAS-2）.For each cut-off stage of fibrosis, i.e., F ≥ 1, F ≥ 2, F ≥ 3, and F ≥ 4（METAVIR）, a bivariate random effects model were used to obtain overall sensitivity and specificity, summary receiver operating characteristic（SROC） curve was performed and the area under the curve（AUC） was calculated, the risk of publication bias was judged by funnel plots. Results 1152 articles related were searched,of which 17 studies used in the meta-analysis. A total of 2238 participants were included, the median age was 44.60 and 55.60% of the subjects were men. The chi-square tests of heterogeneity for sensitivity were all significant（χ2=24.38, P=0.0589 for F ≥ 2; χ2=69.53, P0.001 for F ≥ 3; χ2=35.59, P=0.0003 for F ≥ 4.）, as were the tests for heterogeneity of specificity（χ2=47.76, P0.001 for F ≥ 2; χ2=83.42, P0.001 for F ≥ 3; χ2=42.11, P=0.0001 for F ≥ 4）. The significant heterogeneity in both sensitivity and specificity warrants the use of a random-effects model. Summary of sensitivity and specificity were 0.79 and 0.76 for F ≥ 2, 0.72 and 0.73 for F ≥ 3, and 0.76 and 0.82 for F ≥ 4, respectively. And the area under curve（AUC） of summary receiver operating characteristic（SROC） curve of F ≥ 2 is 0.866,F ≥ 3,0.859;F ≥ 4,0.864,respectively. Conclusions RTE has certain value for the diagnosis of liver fibrosis grading in chronic hepatitis, but cannot replace liver biopsy technique.

关 键 词：肝纤维化 肝硬化 实时组织弹性成像 

分 类 号：R575.2[医药卫生—消化系统]