Combined paediatric NAFLD fibrosis index and transient elastography to predict clinically significant fibrosis in children with fatty liver disease
Combined paediatric NAFLD fibrosis index and transient elastography to predict clinically significant fibrosis in children with fatty liver disease
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DOI：
10.1111/liv.12024
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发表时间：
2013-01-01
影响因子：
6.7
通讯作者：
Nobili, Valerio
中科院分区：
文献类型：
--
作者：
Alkhouri, Naim;Sedki, Emad;Nobili, Valerio
背景非酒精性脂肪性肝病（NAFLD）包括从单纯性脂肪变性到脂肪性肝炎，再到纤维化和肝硬化的一系列疾病。儿科NAFLD纤维化指数（PNFI）和瞬时弹性成像（TE）是纤维化的潜在非侵入性标志物。前瞻性评价PNFI和TE在评估经活检证实的NAFLD儿童临床显著纤维化方面的性能。方法我们的队列包括67例经活检证实的NAFLD儿童。根据非酒精性脂肪性肝炎临床研究网络对纤维化阶段进行评分。纤维化= 2被认为具有临床意义。使用年龄、腰围和甘油三酯计算PNFI。使用Fibroscan装置进行TE。结果10例患者纤维化分期为23期，57例患者纤维化分期为01期。肺纤维化程度越重，PNFI和TE值越高（P < 0.05）。PNFI和TE预测显著纤维化的ROC曲线下面积分别为0.747和1.00（P = 0.005）。联合使用PNFI和TE可以预测98%的NAFLD儿童是否存在临床显著的纤维化。结论在NAFLD患儿中，PNFI和TE联合应用可准确评估临床显著肝纤维化的存在。这将有助于确定应该接受肝活检的患者，因为晚期纤维化的确认将导致更密切的随访和筛查与肝纤维化相关的并发症。
Background Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of disease from simple steatosis to steatohepatitis, to fibrosis and cirrhosis. The paediatric NAFLD fibrosis index (PNFI) and transient elastography (TE) are potential noninvasive markers for fibrosis. To prospectively evaluate the performance of PNFI and TE in assessing clinically significant fibrosis in children with biopsy-proven NAFLD. Methods Our cohort consisted of 67 consecutive children with biopsy-proven NAFLD. The stage of fibrosis was scored according to the Nonalcoholic Steatohepatitis Clinical Research Network. Fibrosis = 2 was considered clinically significant. PNFI was calculated using age, waist circumference and triglycerides. TE was performed using the Fibroscan apparatus. Results Ten patients had fibrosis stage 23 and 57 patients had stage 01. Both PNFI and TE values were significantly higher in patients with significant fibrosis (P < 0.05). The area under the receiver operating characteristic (ROC) curve for predicting significant fibrosis of PNFI and TE were 0.747 and 1.00 respectively (P = 0.005). The combined use of PNFI and TE could predict the presence or absence of clinically significant fibrosis in 98% of children with NAFLD. Conclusions In children with NAFLD, the combination of PNFI and TE can be used to accurately assess the presence of clinically significant liver fibrosis. This will help to identify patients who should undergo liver biopsy because the confirmation of advanced fibrosis would lead to closer follow-up and screening for cirrhosis-related complications.