【摘要】 目的应用meta分析评价瞬时弹性成像(Fibroscan)、谷草转氨酶-血小板计数比值(APRI)及其联合诊断慢性乙型肝炎(CHB)肝纤维化(F≥2)的价值。方法检索数据库包括PubMed、Embase、Cochrane图书馆、维普资讯中文期刊服务平台(VIP)、中国知网(CNKI)、万方数据知识服务平台等筛选其中Fibroscan、APRI及其联合评估CHB肝纤维化分级的文献,应用Stata14.0软件分析纳入文献的相关数据。结果总计纳入文献5篇(857例患者),Fibroscan、APRI诊断CHB肝纤维化(F≥2)的合并灵敏度分别为0.62、0.78,Fibroscan诊断CHB肝纤维化(F≥2)的合并灵敏度明显低于APRI(95%CI:0.55~0.68、0.64~0.87),Fibroscan、APRI诊断CHB肝纤维化(F≥2)的合并特异度分别为0.89、0.76,Fibroscan诊断CHB肝纤维化(F≥2)的合并特异度与APRI无明显差别(95%CI:0.78~0.94、0.61~0.86)。Fibroscan、APRI诊断CHB肝纤维化(F≥2)的合并阳性似然比分别为5.37、3.23,Fibroscan诊断CHB肝纤维化(F≥2)的合并阳性似然比与APRI无明显差别(95%CI:2.76~10.46、2.13~4.90);Fibroscan、APRI诊断CHB肝纤维化(F≥2)的合并阴性似然比分别为0.43、0.29,Fibroscan诊断CHB肝纤维化(F≥2)的合并阴性似然比与APRI无明显差别(95%CI:0.36~0.52、0.20~0.43);Fibroscan、APRI诊断CHB肝纤维化(F≥2)的合并诊断比值比分别为12.44、11.05,Fibroscan诊断CHB肝纤维化(F≥2)的合并诊断比值比与APRI无明显差别(95%CI:5.73~6.99、7.24~16.87)。Fibroscan联合APRI诊断CHB肝纤维化(F≥2)的合并灵敏度、合并特异度、合并诊断比值比分别为0.86、0.78、21.98,明显高于Fibroscan、APRI(95%CI:0.69~0.95、0.68~0.85、8.38~57.64)。Fibroscan、APRI、Fibroscan联合APRI诊断肝纤维化(F≥2)的综合受试者工作特征曲线下面积分别为0.74、0.84、0.87,Fibroscan联合APRI诊断CHB肝纤维化(F≥2)的综合受试者工作特征曲线下面积明显优于Fibroscan、APRI(95%CI:0.83~0.89、0.70~0.77、0.80~0.87)。结论 Fibroscan与APRI联合协同诊断CHB肝纤维化(F≥2)优于其单独诊断,准确性较高。更多还原

【Abstract】 Objective To evaluate the diagnostic value of Fibroscan,APRI and their combination in hepatic fibrosis stage(≥ F2)of chronic hepatitis B(CHB)patients through a meta-analysis. Methods The articles related to assessment of hepatic fibrosis stage by Fibroscan,APRI and their combination in PubMed,Embase,Cochrane library,VIP,CNKI and Wanfang were collected,while the Stata 14.0 software were applied to analyze the related data of enrolled articles. Results A total of 5 Chinese articles were included,involved 857 cases. The pooled sensitivity of Fibroscan and APRI for hepatic fibrosis stage(F≥2)of CHB patients was 0.62 and 0.78 respectively,and the pooled sensitivity of the former(95%CI:0.55-0.68)was obviously lower than that of the latter(95%CI:0.64-0.87);the pooled specificity of Fibroscan and APRI for hepatic fibrosis stage(F≥2)of CHB patients was 0.89 and 0.76 respectively,and the pooled specificity of Fibroscan(95%CI:0.78-0.94)and APRI(95%CI:0.61-0.86)showed no obviously difference;the pooled positive likelihood ratio of Fibroscan and APRI for hepatic fibrosis stage(F≥2)of CHB patients was 5.37 and 3.23 respectively,and the pooled positive likelihood ratio of Fibroscan(95%CI:2.76-10.46)and APRI(95%CI:2.13-4.90)showed no obvously difference;the pooled negative likelihood ratio of Fibroscan and APRI for hepatic fibrosis stage(F≥2)of CHB patients was 0.43 and 0.29 respectively,and the pooled negative likelihood ratio of Fibroscan(95%CI:0.36-0.52)and APRI(95%CI:0.20-0.43)showed no remarkable difference;the pooled diagnostic odds ratio of Fibroscan and APRI for hepatic fibrosis stage(F≥2)of CHB patients was 12.44 and 11.05 respectively,and the pooled diagnostic odds ratio of Fibroscan(95%CI:5.73-6.99)and APRI(95%CI:7.24-6.87)showed no remarkable difference. The pooled sensitivity,specificity,diagnostic odds ratio of Fibroscan combined with APRI for hepatic fibrosis stage(F≥2)of CHB patients were 0.86,0.78,21.98 respectively,thats were obviously higher than Fibroscan and APRI. The area under curve(AUC)of Fibroscan,APRI and Fibroscan combined with APRI for hepatic fibrosis stage(F≥2)of CHB patients was 0.74,0.84 and 0.87 respectively,and the AUC of combination of Fibroscan and APRI(95%CI:0.83-0.89)was superior to that of Fibroscan(95%CI:0.70-0.77)and APRI(95%CI:0.80-0.87). Conclusion Fibroscan combined with APRI has a high diagnostic accuracy for hepatic fibrosis stage(F≥2)of CHB patients,and it is better than Fibroscan or APRI individually.更多还原