FibroScan诊断慢性乙型肝炎肝纤维化的系统评价

Value of Fibro Scan for the Staging of Liver Fibrosis in Chronic Hepatitis B:A Systematic Review

目的系统评价Fibro Scan对慢性乙型肝炎肝纤维化的诊断价值。方法计算机检索Pub Med、EMbase、Web of Knowledge、CBM、Wan Fang Data和CNKI数据库,查找关于Fibro Scan诊断慢性乙型肝炎肝纤维化的相关研究,检索时限均为2003年1月1日至2013年8月31日。由2位评价员按纳入与排除标准独立筛选文献、提取资料并评价纳入研究的方法学质量后,采用Stata 13.0软件进行Meta分析。结果共纳入15个研究,2 588例患者。Meta分析结果显示:1 Fibro Scan诊断明显肝纤维化的合并灵敏度(Sen)、特异度(Spe)、阳性似然比(+LR)、阴性似然比(–LR)、诊断比值比(DOR)、SROC曲线下面积(AUC)分别为0.77[95%CI(0.69,0.83)]、0.8[95%CI(0.70,0.87)]、3.8[95%CI(2.6,5.6)]、0.29[95%CI(0.22,0.38)]、13[95%CI(8,21)]、0.85[95%CI(0.82,0.88)];2 Fibro Scan诊断早期肝硬化的合并Sen、Spe、+LR、–LR、DOR、SROC–AUC分别为0.81[95%CI(0.73,0.87)]、0.89[95%CI(0.86,0.92)]、7.5[95%CI(5.3,10.3)]、0.21[95%CI(0.14,0.31)]、36[95%CI(20,65)]、0.93[95%CI(0.90,0.95)]。结论现有证据表明,Fibro Scan对慢性乙型肝炎早期肝硬化的诊断价值较好,但对明显肝纤维化诊断价值不高。

Objective To systematically review the diagnostic value of FibroScan for the staging of liver fibrosis in chronic hepatitis B. Methods We searched the PubMed, EMbase, Web of Knowledge, CBM, WanFang Data and CNKI databases for studies investigated the diagnostic value of FibroScan for hepatic fibrosis B from Jan. 1^st, 2003 to Aug. 31^st, 2013. Two reviewers independently screened literature according to the exclusion and inclusion criteria, extracted data and assessed methodological quality of included studies. Then, Stata 13.0 software was used to analyze the data. Results A total of 15 studies involving 2 588 patients were included. The results of meta-analysis showed that： the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and the AUC of SROC were 0.77 （95%CI 0.69 to 0.83）, 0.84 （95%CI 0.70 to 0.87）, 3.8 （95%CI 2.6 to 5.6）, 0.29 （95%CI 0.22 to 0.38）, 13 （95%CI 8 to 21）, 0.82 （95%CI 0.82 to 0.88） for hepatic fibrosis; and were 0.81 （95%CI 0.73 to 0.87）, 0.89 （95%CI 0.86 to 0.92）, 7.5 （95%CI 5.3 to 10.3）, 0.21 （95%CI 0.14 to 0.31）, 36 （95%CI 20 to 65）, 0.93 （95%CI 0.90 to 0.95） for early hepatic cirrhosis, respectively. Conclusion The current evidence suggests that FibroScan is of good accuracy in the diagnosis of early hepatic fibrosis but not for hepatic cirrhosis in patient with chronic hepatitis B.