用于评估脂肪变性的控制衰减参数（CAP）技术的个体患者数

StephenW

J Hepatol. 2016 Dec 27. pii: S0168-8278(16)30755-3. doi: 10.1016/j.jhep.2016.12.022. [Epub ahead of print]
Individual Patient Data Meta-Analysis of Controlled Attenuation Parameter (CAP) Technology for Assessing Steatosis.Karlas T1, Petroff D2, Sasso M3, Fan JG4, Mi YQ5, de Lédinghen V6, Kumar M7, Lupsor-Platon M8, Han KH9, Cardoso AC10, Ferraioli G11, Chan WK12, Wai-Sun Wong V13, Myers RP14, Chayama K15, Friedrich-Rust M16, Beaugrand M17, Shen F4, Hiriart JB6, Sarin SK7, Badea R8, Sik Jung K9, Marcellin P10, Filice C11, Mahadeva S12, Lai-Hung Wong G13, Crotty P14, Masaki K15, Bojunga J16, Bedossa P18, Keim V1, Wiegand J19.
Author information

• 1Division of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany.
• 2Clinical Trial Centre, University of Leipzig, Leipzig, Germany; IFB AdiposityDiseases, University of Leipzig, Leipzig, Germany.
• 3R & D Department, Echosens, Paris, France.
• 4Center for Fatty Liver, Department of Gastroenterology, XinHua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
• 5Research Institute of Liver Diseases, Tianjin Second People's Hospital, Tianjin, China.
• 6Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France.
• 7Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
• 8Department of Medical Imaging, Iuliu Hatieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", Cluj-Napoca, Romania.
• 9Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
• 10Department of Hepatology and INSERM U773-CRB3, Hôpital Beaujon, APHP, University of Paris 7, Clichy, France.
• 11Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Medical School University of Pavia, Pavia, Italy.
• 12Gastroenterology and Hepatology Unit, Gastrointestinal Endoscopy Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
• 13Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.
• 14Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
• 15Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
• 16Department of Internal Medicine, J.W. Goethe-University Hospital, Frankfurt, Germany.
• 17Department of Hepatology, Hôpital Jean Verdier, Bondy, France.
• 18Department of Pathology, Physiology and Imaging, University Paris Diderot, Paris, France.
• 19Division of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany. Electronic address: [email protected].
  

AbstractBACKGROUND: The prevalence of fatty liver underscores the need for non-invasive characterization of steatosis, such as the ultrasound-based controlled attenuation parameter (CAP). Despite good diagnostic accuracy, clinical use of CAP is limited due to uncertainty regarding optimal cut-offs and the influence of covariates. We therefore conducted an individual patient data meta-analysis.
METHODS: A review of the literature identified studies containing histology controlled CAP data (M probe, vibration controlled transient elastography with Fibroscan) for grading of steatosis (S0-S3). Receiver operating characteristic analysis after correcting for center effects was used as well as mixed models to test the impact of covariates on CAP. The primary outcome was establishing CAP cut-offs for distinguishing steatosis grades.
RESULTS: Data from 19/21 eligible papers were provided, comprising 3830/3968 (97%) of patients. Considering data overlap and exclusion criteria, 2735 patients were included in the final analysis (37% hepatitis B, 36% hepatitis C, 20% NAFLD/NASH, 7% other). Steatosis distribution was 51%/27%/16%/6% for S0/S1/S2/S3. CAP values in dB/m (95% CI) were influenced by several covariates with an estimated shift of 10 (4.5-17) for NAFLD/NASH patients, 10 (3.5-16) for diabetics and 4.4 (3.8-5.0) per BMI unit. Areas under the curves were 0.823 (0.809-0.837) and 0.865 (0.850-0.880) respectively. Optimal cut-offs were 248 (237-261) and 268 (257-284) for those above S0 and S1 respectively.
CONCLUSIONS: CAP provides a standardized non-invasive measure of hepatic steatosis. Prevalence, etiology, diabetes, and BMI deserve consideration when interpreting CAP. Longitudinal data are needed to demonstrate how CAP relates to clinical outcomes.
LAY SUMMARY: There is an increase in fatty liver for patients with chronic liver disease, linked to the epidemic of the obesity. Invasive liver biopsies are considered the best means of diagnosing fatty liver. The ultrasound based "controlled attenuation parameter (CAP)" can be used instead, but factors such as the underlying disease, BMI and diabetes must be taken into account.

Copyright © 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

KEYWORDS: Controlled attenuation parameter (CAP); liver steatosis; transient elastography (TE)

PMID:28039099DOI:10.1016/j.jhep.2016.12.022

StephenW

J Hepatol。 2016十二月27. pii：S0168-8278（16）30755-3。 Doi：10.1016 / j.jhep.2016.12.022。 [打印前的电子版]
用于评估脂肪变性的控制衰减参数（CAP）技术的个体患者数据元分析。
Karlas T1，Petroff D2，Sasso M3，Fan JG4，Mi YQ5，deLédinghenV6，Kumar M7，Lupsor-Platon M8，Han KH9，Cardoso AC10，Ferraioli G11，Chan WK12，Wai-Sun Wong V13，Myers RP14，Chayama K15 ，Friedrich-Rust M16，Beaugrand M17，Shen F4，Hiriart JB6，Sarin SK7，Badea R8，Sik Jung K9，Marcellin P10，Filice C11，Mahadeva S12，Lai-Hung Wong G13，Crotty P14，Masaki K15，Bojunga J16，Bedossa P18，Keim V1，Wiegand J19。
作者信息

德国Leipzig莱比锡大学医院消化内科和风湿病学1个部门。
2临床试验中心，莱比锡大学，莱比锡，德国; IFB Adiposity Diseases，莱比锡大学，莱比锡，德国。
3R＆D部门，Echosens，巴黎，法国。
4上海交通大学医学院新华医院消化内科，脂肪肝中心，上海。
5天津市第二人民医院肝病研究所，天津。
6Centre d'Investigation de la Fibrosehépatique，HôpitalHaut-Lévêque，Centre Hospitalo-Bourgeaux，Pessac，France。
7肝脏病学，肝脏和胆道科学研究所，新德里，印度。
8医学影像部，尤利乌·加拿大医学和药学大学，区域胃肠病学和肝病学研究所“Octavian Fodor教授”，罗马尼亚克卢日纳波卡。
9延世大学医学院内科学系，韩国首尔。
10肝脏病科和INSERM U773-CRB3，HôpitalBeaujon，APHP，巴黎大学7，Clichy，法国。
11传染病传染病基金会IRCCS Policlinico San Matteo，医学院帕维亚大学，帕维亚，意大利。
12马来西亚大学马来西亚大学医学院胃肠内镜单位消化内科和肝脏病学科。
13香港中文大学医学与治疗学系，香港沙田。
卡尔加里大学医学系胃肠病学和肝脏病学系肝病学科，加拿大阿尔伯塔省卡尔加里市。
15部门的消化内科和代谢，广岛大学医院，广岛，日本。
16德国法兰克福的歌德大学医院内科学系。
17法国Bondy Jean Verdier医院肝脏病学系。
18病理，生理和成像，巴黎狄德罗大学，巴黎，法国的部门。
19德国莱比锡大学莱比锡大学医院消化内科和风湿病学。电子地址：[email protected]。

抽象
背景：

脂肪肝的流行强调了对脂肪变性的非侵入性表征的需要，例如基于超声的受控衰减参数（CAP）。尽管良好的诊断准确性，CAP的临床使用是有限的，因为不确定性的最佳临界值和协变量的影响。我们进行个别患者数据荟萃分析。
方法：

文献回顾确定了用于脂肪变性分级（S0-S3）的包含组织学控制的CAP数据（M探针，具有Fibroscan的振动控制瞬时弹性成像）的研究。使用校正中心效应后的受试者工作特征分析以及混合模型来测试协变量对CAP的影响。主要结果是建立CAP截止，以区分脂肪变性等级。
结果：

提供了来自19/21个合格文件的数据，包括3830/3968（97％）的患者。考虑数据重叠和排除标准，2735例患者纳入最终分析（37％乙型肝炎，36％丙型肝炎，20％NAFLD / NASH，7％其他）脂肪变性分布为51％/ 27％/ 16％对于S0 / S1 / S2 / S3。以dB / m（95％CI）的CAP值受几种协变量的影响，NAFLD / NASH患者的曲线的估计面积分别为0.823（0.809-0.837）和0.865（0.850-0.880）糖尿病和4.4（3.8-5.0）每BMI单位。 ） 分别。对于S0和S1以上的那些，最佳截止值分别为248（237-261）和268（257-284）。
结论：

CAP提供了肝脏脂肪变性的标准化非侵入性测量。在解释CAP时，患病率，病因，糖尿病和BMI值得考虑。需要纵向数据来证明CAP如何与临床结果相关。
总结：

慢性肝病患者的脂肪肝增加，与肥胖的流行有关。侵入性肝活检被认为是诊断脂肪肝的最佳方法。可以使用基于超声的“受控衰减参数（CAP）”，但是诸如潜在疾病，BMI和糖尿病的因素必须考虑.