磁共振弹性成像对肝纤维化分级诊断价值的Meta分析

目的：采用Meta分析方法探讨磁共振弹性成像（MRE）对肝纤维化分级的诊断效能及临床应用价值，为临床对肝纤维化的治疗提供依据。方法：搜索2017年2月2日前国内外公开发表的MRE诊断肝纤维化分级的中文和英文文献。纳入数据库包括PubMed、EMBase、Web of Science、Cochrane Library、中国知网、中国生物医学文献数据库、维普数据库和万方数据库，并辅以手工检索，按照预先纳入及排除标准进行筛选，提取资料，采据QUADAS-2工具进行文献质量评价，采用Stata软件分别对F0 vs F1-F4组、F0-F1 vs F2-F4组、F0-F2 vs F3-F4组和F0-F3 vs F4组MRE对肝纤维化分期诊断的敏感度（SEN）、特异度（SPE）、诊断比值比（DOR）、阳性似然比（+LR）和阴性似然比（-LR）进行合并计算及异质性检验，绘制分层综合受试者工作特征曲线（HSROC），计算曲线下面积（AUROC）。结果：共检索出1 332篇文献，最后纳入22篇，其中英文21篇，中文1篇。Meta分析，SEN_合并、SPE_合并、+LR_合并、-LR_合并、DOR_合并和AUROC，F0 vs F1-F4组分别为88.8%（85.0%~91.7%）、95.9%（91.5%~98.0%）、21.435（10.215~44.979）、0.117（0.086~0.159）、183.187（72.533~462.650）和0.96（0.94~0.98），F0-F1 vs F2-F4组分别为93.3%（89.2%~35.9%）、94.1%（90.2%~96.5%）、15.839（9.344~26.848）、0.072（0.044~0.117）、221.224（100.980~484.648）和0.98（0.96~0.99），F0-F2 vs F3-F4组分别为92.9%（88.9%~95.5%）、94.6%（91.2%~96.8%）、17.348（10.496~28.671）、0.075（0.048~0.119）、230.434（111.482~476.317）和0.98（0.96~0.99），F0-F3 vs F4组分别为97.7%（93.0%~99.3%）、93.2%（90.3%~95.2%）、14.337（9.910~20.742）、0.025（0.008~0.075）、580.405（144.871~2 325.307）和0.98（0.96~0.99）。结论：MRE作为一种新型和无创的影像检查手段，对不同分期肝纤维化均具有较高诊断价值，可为临床肝纤维化的精准治疗提供可靠参考。

Values of MRE in diagnosis of stages of hepaticfibrosis:A Meta-analysis

Objective:To investigate the efficacy and the clinical value of magnetic resonance elastography(MRE) in diagnosis of hepatic fibrosis with Meta-analysis, and to provide basis for clinical treatment of hepatic fibrosis.Methods:The studies published before February 2, 2017 about MRE and staging of hepatic fibrosis in Chinese or English were retrived in the databases including PubMed, EMBase, Web of Science, Cochrane Library,CNKI, CBMDisc,VIP, Wanfang data, and supplemented by manual retrieval for relevant literatures.The inclusion and exclusion criterions were used to select and extract the literatures.The literatures qualitie were valuated based on QUADAS-2 tool.The sensitivity(SEN), specificity (SPE), diagnostic odds ratio (DOR), positive likelihood ratio (+LR), negative likelihood ratio (-LR) on the groups of F0 vs F1-F4,F0-F1 vs F2-F4,F0-F2 vs F3-F4, F0-F3 vs F4 and heterogeneity were combined and tested with Stata software respectively.HSROC and AUROC were also implemented.Results:A total of 1 332 studies were searched, and 22 were included.21 of them were in English and 1 in Chinese.The results of Meta analysis showed that the SENp, SPEp, +LRp,-LRp, DOR and AUROC in F0 vs F1-F4 group were 88.8%(85.0-91.7),95.9%(91.5-98.0),21.435(10.215-44.979),0.117(0.086-0.159),183.187(72.533-462.650) and 0.96(0.94-0.98) ,respectively;the SENp, SPEp, +LRp,-LRp, DOR and AUROC in F0-F1 vs F2-F4 group were 93.3%(89.2%-35.9%), 94.1%(90.2%-96.5%),15.839(9.344-26.848),0.072(0.044-0.117),221.224(100.980-484.648) and 0.98(0.96-0.99),respectively;the SENp, SPEp, +LRp, -LRp, DOR and AUROC in F0-F2 vs F3-F4 group were 92.9%(88.9%-95.5%),94.6%(91.2%-96.8%),17.348(10.496-28.671),0.075(0.048-0.119),230.434(111.482-476.317)0.98(0.96-0.99), respectively;the SENp, SPEp, +LRp,-LRp, DOR and AUROC in F0-F3 vs F4 group were 97.7%(93.0%-99.3%),93.2%(90.3%-95.2%),14.337(9.910-20.742),0.025(0.008-0.075),580.405(144.871-2325.307) and 0.98(0.96-0.99),respectively.Conclusion:MRE,as a new and noninvasive imaging method, has high diagnostic value in all stages of hepatic fibrosis, which can provide a reliable reference for clinical precise treatment of hepatic fibrosis.