The use of transient elastography and non-invasive serum markers of fibrosis in pediatric liver transplant recipients
The use of transient elastography and non-invasive serum markers of fibrosis in pediatric liver transplant recipients
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DOI：
10.1111/petr.12116
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发表时间：
2013-09-01
影响因子：
1.3
通讯作者：
Baumann, Ulrich
中科院分区：
文献类型：
--
作者：
Goldschmidt, Imeke;Stieghorst, Henrik;Baumann, Ulrich
在 LTx 治疗后的儿童中，使用非侵入性标记物诊断同种异体肝纤维化的方法尚未成熟。对 117 名肝移植儿童（60M，8.9 [0.5-18.5] 岁）和 336 名健康对照进行了 TE、FT 和 ELF 评分。对 36 名儿童进行了肝活检。酌情使用相关系数或曼-惠特尼 U 检验比较组织学和非侵入性标志物的结果。 TE 与纤维化的组织学程度相关性最好（r = 0.85 与 r = 0.04 [FT] 或 r = -0.38 [ELF]）。无纤维化的移植儿童的肝脏硬度值显着高于健康对照（7.55 [5.4-20.4] kPa vs. 4.5 [2.5-8.9] kPa）。排斥的存在是 TE 性能的一个潜在混杂因素。 TE 和 FT 均反映了总共 16 名接受连续测量的患者的临床变化（急性排斥反应、胆汁淤积、纤维化加剧）。与 FT 或 ELF 相比，TE 与肝移植儿童的纤维化组织学程度相关性更好，但需要为每个患者确定单独的基线值。纤维化病理程度的正常值或截止值不能从非移植儿童身上转移。后续研究，最好是协议活检，可能有助于提高 TE 的诊断质量。
The use of non-invasive markers to diagnose liver allograft fibrosis is not well established in children after LTx. TE, FT, and ELF score were performed in 117 liver-transplanted children (60M, 8.9 [0.5-18.5] yr) and 336 healthy controls. Liver biopsy was available in 36 children. Results of histology and non-invasive markers were compared using correlation coefficient or Mann-Whitney U-test as appropriate. TE correlated best with histological degree of fibrosis (r = 0.85 vs. r = 0.04 [FT] or r = -0.38 [ELF]). Liver stiffness values for transplanted children without fibrosis were significantly higher than those of healthy controls (7.55 [5.4-20.4] kPa vs. 4.5 [2.5-8.9] kPa). Presence of rejection was a potent confounder for the performance of TE. Both TE and FT reflected clinical changes (acute rejection, cholestasis, increasing fibrosis) in a total of 16 patients who underwent serial measurements. TE correlates better with histological degree of fibrosis in liver-transplanted children than FT or ELF, but an individual baseline value needs to be determined for each patient. Normal or cutoff values for pathological degrees of fibrosis cannot be transferred from non-transplanted children. Follow-up studies, preferably with protocol biopsies, might help to improve the diagnostic quality of TE.