循环mi RNAs对乙肝患者肝纤维化诊断价值的荟萃分析  

Meta-analysis of diagnostic value of circulating micro RNAs in hepatitis B-related fibrosis

作　　者：路晴晴 陈敏[2] 王晓林[1] 曹仕琼[1] Qing-Qing Lu;Min Chen;Xiao-Lin Wang;Shi-Qiong Cao(Department of Gastroenterology,Liyuan Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430061,Hubei Province,China;Department of Emergency Medicine,Liyuan Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430061,Hubei Province,China)

机构地区：[1]华中科技大学同济医学院附属梨园医院消化内科,湖北省武汉市430061 [2]华中科技大学同济医学院附属梨园医院急诊内科,湖北省武汉市430061

出　　处：《世界华人消化杂志》2019年第22期1365-1374,共10页World Chinese Journal of Digestology

摘　　要：背景乙型肝炎病毒(hepatitis B virus,HBV)感染是全球病毒性肝炎、肝纤维化及肝硬化(liver cirrhosis,LC)的主要病因.肝纤维化最初是可逆的,但如果缺乏早期诊断和及时治疗,它将进展至终末期肝病,如LC、肝衰竭,甚至肝癌.因此,肝纤维化的准确分期在慢性乙肝(chronic hepatitis B,CHB)患者的管理和治疗起着决定性的作用.然而,目前尚缺乏被认可并广泛应用于临床的诊断标记物.目的采用荟萃分析的方法评价循环miRNAs对CHB相关肝纤维化的诊断价值.方法以“serum/plasma/circulating/blood”和“microRNA/miRNA/miR*”和“Hepatitis B/CHB/viral hepatitis*/chronic hepatitis”和“liver fibrosis/liver cirrhosis/hepatic fibrosis*”为关键词,系统检索PubMed、Cochrane图书馆和Embase数据库的相关临床研究文献.并对纳入文献进行归纳和统计学分析,评估循环miRNAs诊断早期肝纤维化、进展期肝纤维化以及LC的敏感性、特异性、阳性似然比、阴性似然比、诊断比值比、以及受试者工作特征曲线下面积(the area under the receiver operating characteristic curves,AUROC).结果最终15项研究共计1623例CHB患者被纳入.其中9项研究评估了循环miRNAs对早期肝纤维化的诊断效能,结果显示合并的敏感度、特异度及AUROC值分别为0.76(95%CI:0.69-0.82)、0.64(95%CI:0.47-0.78)和0.78(95%CI:0.74-0.81).4项研究评估了循环miRNAs对进展期肝纤维化的诊断效能,结果显示合并的敏感度、特异度及AUROC值分别为0.79(95%CI:0.72-0.85)、0.81(95%CI:0.63-0.91)和0.82(95%CI:0.79-0.85).2项研究评估了循环miRNAs对LC患者的诊断效能,结果显示AUROC=0.882,诊断准确性高达93.7%.结论循环miRNAs对CHB患者的肝纤维化具有良好的诊断效能,尤其对于进展期肝纤维化及LC,可用作CHB患者肝纤维化诊断的潜在血清生物标记物.BACKGROUND Hepatitis B virus(HBV)infection is a major cause of viral hepatitis,liver fibrosis,and liver cirrhosis worldwide.Liver fibrosis is initially reversible,but without early diagnosis and timely treatment,it can progress to endstage liver diseases such as cirrhosis,liver failure,and even liver cancer.Therefore,the accurate diagnosis of hepatic fibrosis plays a decisive role in the management and treatment of chronic hepatitis B(CHB)patients.However,accurate diagnostic markers are still lacking.AIM To systemically evaluate the diagnostic accuracy of circulating microRNAs(miRNAs)in hepatitis B-related fibrosis.METHODS The PubMed,Cochrane Library,and Embase databases were searched for all eligible studies using the following search terms:(“serum”or“plasma”or“circulating”or“blood”)and(“microRNA”or“miRNA”or“miR*”)and(“hepatitis B”or“CHB”or“viral hepatitis*”or“chronic hepatitis”)and(“liver fibrosis”or“liver cirrhosis”or“hepatic fibrosis*”).The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio,and area under the summary receiver operating characteristics curve(AUROC)were pooled to assess the accuracy of circulating miRNAs for the diagnosis of early fibrosis,advanced fibrosis,and cirrhosis.RESULTS A total of 15 studies with 1623 CHB patients were enrolled in this meta-analysis.The pooled sensitivity,specificity,and AUROC of using circulating miRNAs for the diagnosis of hepatitis B-related early fibrosis were 0.76(95%CI:0.69-0.82),0.64(95%CI:0.47-0.78),and 0.78(95%CI:0.74-0.81),respectively.The pooled sensitivity,specificity,and AUROC of using circulating miRNAs for the diagnosis of hepatitis B-related advanced fibrosis were 0.79(95%CI:0.72-0.85),0.81(95%CI:0.63-0.91),and 0.82(95%CI:0.79-0.85),respectively.Only two studies assessed the diagnostic accuracy of circulating miRNAs for predicting cirrhosis,and the results suggested that circulating miRNAs provided a high diagnostic accuracy for CHB-related cirrhosis(A

关 键 词：血清 MIRNA 慢性乙型肝炎 肝纤维化 荟萃分析 

分 类 号：R51[医药卫生—内科学]