| Objective:M2BP glycosylation isomer(M2BPGi)is a new type of glycosylated protein,which has received more and more attention in the diagnosis and treatment of chronic liver diseases in recent years.However,for the pre-judgment of the progress of a significant proportion of patients with chronic viral hepatitis,the special significance of detecting M2 BPGi is not very clear.In this paper,through meta-analysis,we comprehensively evaluate the value of M2 BPGi in the diagnosis of liver fibrosis caused by chronic viral hepatitis,and review the relevant literature to discuss how to use M2 BPGi to predict the risk of hepatocellular carcinoma(HCC)in these patients.Methods:Two researchers searched the literature about M2 BP glycosylated isomers in electronic databases such as Pub Med,EMbase,Cochrane,CNKI,Wang Fang,VIP and CBMdisc,and the deadline for the search was December 31,2019.The standards for inclusion and exclusion of literature were formulated and strictly adhered to.The quality of the included literature was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2(QUADAS-2)tool,and the clinical characteristics and results of the research subjects included in the study were extracted and tabulated.Meta Di Sc 1.4 and STATA 16.0 software were used for statistical analysis,and the combined results were tested for heterogeneity.Random effect models(REM)or Fixed effect models(FEM)were selected for meta-analysis based on the statistical heterogeneity between the included studies.The area under the curve(AUC)was obtained from the summary receiver operating characteristic curve(s ROC)to evaluate the diagnostic ability of M2 BPGi for significant liver fibrosis and advanced liver fibrosis.To explore sources of heterogeneity between studies,threshold effect tests and subgroup analysis were used.When the threshold effect exists,some diagnostic accuracy indicators like sensitivity(SEN)and specificity(SPE)is calculated by constructing a hierarchical comprehensive receiver operating characteristic curve model(HSROC).A Deek’s funnel plot asymmetry test was used to assess publication bias.In addition,by searching the relevant literature about M2 BPGi and hepatocyte carcinogenesis,we comprehensively analyzed the predictive value of M2 BPGi for hepatocyte carcinogenesis.Results:A total of 14 conforming literatures were included in this analysis,including 19 studies.The AUCs of M2 BPGi plotted by s ROC curves for the diagnosis of significant liver fibrosis and advanced liver fibrosis in patients with chronic viral hepatitis were0.77 and 0.78,respectively.According to different etiology,we divided the results into chronic hepatitis B(CHB)subgroup and chronic hepatitis C(CHC)subgroup.In CHB patients,the AUCs for M2 BPGi diagnosis of significant liver fibrosis and advanced liver fibrosis were 0.76 and 0.75,respectively,and in CHC patients they were 0.80 and0.81,respectively.After testing,it was found that a threshold effect exists.The HSROC model was constructed to merge the results of some diagnostic indictors like sensitivity and specificity.The SEN and SPE are 0.69,0.73 And 0.70,0.73 for the diagnosis of significant liver fibrosis and advanced liver fibrosis in patients with chronic viral hepatitis,respectively.The results are 0.68,0.74,and 0.63,0.73 in CHB patients.Other more,the SEN and SPE are 0.73,0.72,and 0.75,0.73 in CHC patients,respectively.There was no obvious publication bias approved by Deek ’s test.By summarizing the relevant literature,it is found that M2 BPGi can also be used to determine the prognosis of patients with chronic viral hepatitis.The increase in M2 BPGi levels means that the risk of HCC also increases accordingly.In general,M2 BPGi levels will decrease significantly after receiving antiviral therapy,but for patients with a higher risk of hepatocyte carcinogenesis,no matter what antiviral regimen is used,or whether they achieve a sustained virological response(SVR),there is no M2 BPGi level after treatment significantly changed.By dynamically observing the changes in M2 BPGi levels before and after antiviral therapy,this part of the high-risk population can be identified early,and comprehensive analysis of the situation that may interfere with the test results can further improve the accuracy of its prognosis.Conclusion:The M2 BPGi test can be used as a reliable option for non-invasive methods to determine the degree of liver fibrosis in patients with chronic viral hepatitis,especially in patients with chronic hepatitis C.High levels of M2 BPGi are a risk factor for hepatocyte carcinogenesis in this part of the patients,even if some of them have received antiviral therapy to achieve effective suppression of hepatitis virus.M2 BPGi has great application potential as a new tumor marker for predicting the risk of hepatocyte carcinogenesis in patients with chronic viral hepatitis. |
