METHODS: We conducted a systematic review and meta-analysis by searching PubMed and Scopus databases for relevant literature evaluating the clinical usefulness of TE for diagnosing CSPH in patients with chronic liver disease.
RESULTS: Twenty-six studies (4337 patients with valid TE and HVPG) met our inclusion criteria. The median correlation coefficient of TE with HVPG was 0.70 (range 0.36-0.86). The weighted mean of optimal cut-off of liver stiffness value for diagnosing CSPH was 22.8 kPa (95% CI 22.7-23.0 kPa). The summary sensitivity and specificity were 79% (95% CI 74-84%) and 88% (95% CI 84-91%), respectively. The area under the hierarchical summary receiver operating characteristic (HSROC) curve was 0.91 (95% CI 0.88-0.93) according to the bivariate model. One limitation of the study was significant heterogeneity in the results of summary sensitivity and specificity (I2 83 and 74%, respectively). The heterogeneity could be explained by the variable liver stiffness cut-offs used in studies. The meta-regression plot revealed that as the optimal cut-off increased, the sensitivity decreased, the specificity increased, and vice versa.
CONCLUSIONS: Liver stiffness measurement using TE correlates well with HVPG, and a liver stiffness cut-off value of 22.8 kPa shows a high accuracy for diagnosing CSPH. Thus, use of TE should be integrated into clinical practice for noninvasive diagnosis of CSPH.
方法:我们通过检索PubMed和Scopus数据库进行了系统综述和荟萃分析,以获取评估TE在慢性肝病患者中诊断CSPH的临床应用的相关文献。
结果:26项研究(4337例TE和HVPG有效患者)符合我们的纳入标准。TE与HVPG的相关系数中位数为0.70(范围为0.36-0.86)。诊断CSPH的最佳肝脏硬度值的加权平均值为22.8kPa(95%CI22.7-23.0kPa)。总体敏感性和特异性分别为79%(95%CI74-84%)和88%(95%CI84-91%),分别。根据双变量模型,分层汇总受试者工作特征(HSROC)曲线下面积为0.91(95%CI0.88-0.93)。该研究的一个局限性是汇总敏感性和特异性结果的显着异质性(I283和74%,分别)。异质性可以通过研究中使用的可变肝脏硬度截止来解释。元回归图显示,随着最佳截止值的增加,灵敏度下降,特异性增加,反之亦然。
结论:使用TE测量肝脏硬度与HVPG相关,和22.8kPa的肝脏硬度截止值显示了诊断CSPH的高准确性。因此,在CSPH的无创性诊断中,应将TE的使用纳入临床实践.