Abstract：
OBJECTIVE: Liver stiffness measurement using transient elastography (TE-LSM) is a promising noninvasive alternative to hepatic venous pressure gradient (HVPG) for diagnosing clinically significant portal hypertension (CSPH). However, previous studies have yielded conflicting results. We evaluated the correlation between TE-LSM and HVPG and the performance of TE-LSM in diagnosing CSPH (HVPG ≥ 10 mmHg).
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.
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.
摘要：
目的：使用瞬时弹性成像（TE-LSM）测量肝脏硬度是一种有前途的非侵入性肝静脉压力梯度（HVPG）的替代方法，用于诊断临床上有意义的门静脉高压（CSPH）。然而,以往的研究结果相互矛盾.我们评估了TE-LSM和HVPG之间的相关性以及TE-LSM诊断CSPH（HVPG≥10mmHg）的性能。
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.
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.
