Ultrasonographic quantitative estimation of hepatic steatosis in children With NAFLD.
Ultrasonographic quantitative estimation of hepatic steatosis in children With NAFLD.
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DOI：
10.1097/mpg.0b013e31821b4b61
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发表时间：
2011-08
影响因子：
2.9
通讯作者：
Nobili V
中科院分区：
文献类型：
--
作者：
Shannon A;Alkhouri N;Carter-Kent C;Monti L;Devito R;Lopez R;Feldstein AE;Nobili V
肝脏超声检查对疑似非酒精性脂肪性肝病 (NAFLD) 儿童肝脏脂肪变性的检测和分级的诊断准确性仍不明确。本研究的目的是前瞻性评估超声定量肝脂肪变性的临床效用。我们的队列由 208 名经活检证实患有 NAFLD 的连续儿科患者组成。肝活检手术后 1 个月内进行肝脏超声检查。根据血管系统、实质和膈肌的回声和可视化，使用 0 到 3 级对超声检查确定的脂肪变性进行评分，并与基于 Brunt 分类的组织学特征进行比较。首次就诊时的中位年龄为 10.8 岁，其中 64% 是男孩。百分之六十九的组织学显示有中度至重度脂肪变性。超声脂肪变性评分 (USS) 与脂肪变性的组织学分级具有良好的相关性（Spearman 系数为 0.80）。超声检测中度至重度脂肪变性的受试者工作特征（ROC）曲线下面积为0.87。 USS 与炎症活动或纤维化阶段没有显着相关性；然而，与 NAFLD 活动评分 (NAS) 存在显着相关性，尽管这在很大程度上是由于与 NAS 的脂肪变性部分有很强的相关性。血清 ALT 和 AST 与脂肪变性的组织学分级无关，并且与 USS 没有相关性。我们的结果代表了评估肝脏超声检查在活检证实的 NAFLD 儿童中的作用的最大规模的前瞻性儿科研究，证明了该技术在儿童肝脏脂肪变性的无创诊断和评估中的实用性。
The diagnostic accuracy of hepatic ultrasonography for detection and grading of hepatic steatosis in children with suspected nonalcoholic fatty liver disease (NAFLD) remains poorly characterized. The aim of this study was to prospectively evaluate the clinical utility of ultrasonographic quantification of hepatic steatosis. Our cohort consisted of 208 consecutive pediatric patients with biopsy-proven NAFLD. Hepatic ultrasonography was performed within 1-month of the liver biopsy procedure. Steatosis identified by ultrasonography was scored using a 0 to 3 scale based on echogenicity and visualization of vasculature, parenchyma and diaphragm and compared to histological features based on Brunt’s classification. The median age at time of first visit was 10.8 years and 64% were boys. Sixty-nine percent had moderate to severe steatosis on histology. Ultrasonographic steatosis score (USS) had an excellent correlation with histological grade of steatosis (with a Spearman’s coefficient of 0.80). The area under the receiver operating characteristic (ROC) curve for ultrasonographic detection of moderate to severe steatosis was 0.87. The USS did not correlate significantly with inflammatory activity or fibrosis stage; however, there was significant correlation with the NAFLD activity score (NAS) albeit this was due in large part to the strong correlation with the steatosis component of NAS. Serum ALT and AST were not associated with histological grade of steatosis and showed no correlation with USS. Our results, which represent the largest prospective pediatric study evaluating the role of hepatic ultrasonography in children with biopsy-proven NAFLD, demonstrate the utility of this technique for non-invasive diagnosis and estimation of hepatic steatosis in children.