Diagnostic Accuracy of Transient Elastography for Staging Liver Fibrosis in Autoimmune Liver Diseases: A Systematic Review and Meta-Analysis.

IF 14 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical and Molecular Hepatology Pub Date : 2024-08-21 DOI:10.3350/cmh.2024.0586

Jihyun An, Young Eun Chon, Gunho Kim, Mi Na Kim, Hee Yeon Kim, Han Ah Lee, Jung Hwan Yu, Miyoung Choi, Dae Won Jun, Seung Up Kim, Ji Won Han, Young-Joo Jin

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引用次数: 0

Abstract

Background/aims: The assessment of liver fibrosis is crucial for managing autoimmune liver diseases such as primary biliary cholangitis (PBC), autoimmune hepatitis (AIH), and primary sclerosing cholangitis (PSC). However, data on the efficacy of noninvasive tests (NITs) for these diseases are limited. This meta-analysis evaluated the diagnostic accuracy of vibration-controlled transient elastography (VCTE) for staging fibrosis in patients with autoimmune liver disease.

Methods: Searches were conducted in PubMed, Embase, CINAHL, Web of Science, and Cochrane Library databases to assess the diagnostic accuracy of VCTE against histology as the reference standard in adult patients with autoimmune liver disease. The summary area under the curve (sAUC) and diagnostic odds ratio were calculated for significant fibrosis (SF), advanced fibrosis (AF), and cirrhosis, defined as METAVIR stages F≥2, F≥3, and F=4, respectively, according to liver biopsy.

Results: Fourteen articles were included, comprising 559 PBC patients from six studies, 388 AIH patients from five studies, and 151 PSC patients from three studies. VCTE demonstrated good performance for fibrosis staging in PBC, AIH, and PSC. In PBC, sAUCs of VCTE were 0.87 (95% confidence interval, 0.80-0.94), 0.89 (0.85-0.94), and 0.99 (0.96-1.00) for staging SF, AF, and cirrhosis, respectively. In AIH, the sAUCs were 0.88 (0.84-0.92), 0.88 (0.83-0.93), and 0.92 (0.88-0.96), respectively, while in PSC, they were 0.88 (0.82-0.95), 0.95 (0.90-1.00), and 0.92 (0.84-0.99), respectively. The cutoff values for AF were 7.5-17.9 kPa in PBC, 8.18-12.1 kPa in AIH, and 9.6 kPa in PSC.

Conclusions: VCTE shows high diagnostic accuracy for staging liver fibrosis in patients with autoimmune liver diseases such as PBC, AIH, and PSC. This non-invasive and reliable method serves as a valuable tool for the evaluation and monitoring of fibrosis in these lifelong diseases.

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瞬态弹性成像对自身免疫性肝病肝纤维化分期的诊断准确性：系统回顾与元分析

背景/目的：评估肝纤维化对于管理原发性胆汁性胆管炎（PBC）、自身免疫性肝炎（AIH）和原发性硬化性胆管炎（PSC）等自身免疫性肝病至关重要。然而，有关这些疾病的无创检验（NIT）疗效的数据却很有限。这项荟萃分析评估了振动控制瞬态弹性成像（VCTE）对自身免疫性肝病患者纤维化分期的诊断准确性：方法：在PubMed、Embase、CINAHL、Web of Science和Cochrane Library数据库中进行检索，评估振动控制瞬态弹性成像（VCTE）与作为参考标准的组织学相比，对自身免疫性肝病成人患者的诊断准确性。根据肝活检结果，计算了明显纤维化（SF）、晚期纤维化（AF）和肝硬化（分别定义为METAVIR F≥2、F≥3和F=4期）的曲线下面积（sAUC）和诊断几率比：共纳入14篇文章，包括6项研究中的559例PBC患者、5项研究中的388例AIH患者和3项研究中的151例PSC患者。VCTE在PBC、AIH和PSC的纤维化分期方面表现良好。在 PBC 中，VCTE 对 SF、AF 和肝硬化分期的 sAUC 分别为 0.87（95% 置信区间，0.80-0.94）、0.89（0.85-0.94）和 0.99（0.96-1.00）。在 AIH 中，sAUC 分别为 0.88（0.84-0.92）、0.88（0.83-0.93）和 0.92（0.88-0.96）；在 PSC 中，sAUC 分别为 0.88（0.82-0.95）、0.95（0.90-1.00）和 0.92（0.84-0.99）。心房颤动的临界值在 PBC 为 7.5-17.9 kPa，在 AIH 为 8.18-12.1 kPa，在 PSC 为 9.6 kPa：VCTE对PBC、AIH和PSC等自身免疫性肝病患者的肝纤维化分期具有很高的诊断准确性。这种无创、可靠的方法是评估和监测这些终身疾病肝纤维化的重要工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Molecular Hepatology Medicine-Hepatology

CiteScore

15.60

自引率

9.00%

发文量

审稿时长

10 weeks

期刊介绍： Clinical and Molecular Hepatology is an internationally recognized, peer-reviewed, open-access journal published quarterly in English. Its mission is to disseminate cutting-edge knowledge, trends, and insights into hepatobiliary diseases, fostering an inclusive academic platform for robust debate and discussion among clinical practitioners, translational researchers, and basic scientists. With a multidisciplinary approach, the journal strives to enhance public health, particularly in the resource-limited Asia-Pacific region, which faces significant challenges such as high prevalence of B viral infection and hepatocellular carcinoma. Furthermore, Clinical and Molecular Hepatology prioritizes epidemiological studies of hepatobiliary diseases across diverse regions including East Asia, North Asia, Southeast Asia, Central Asia, South Asia, Southwest Asia, Pacific, Africa, Central Europe, Eastern Europe, Central America, and South America. The journal publishes a wide range of content, including original research papers, meta-analyses, letters to the editor, case reports, reviews, guidelines, editorials, and liver images and pathology, encompassing all facets of hepatology.

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