Transient Elastography Is a Useful Noninvasive Tool for the Evaluation of Fibrosis in Paediatric Chronic Liver Disease
Transient Elastography Is a Useful Noninvasive Tool for the Evaluation of Fibrosis in Paediatric Chronic Liver Disease
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DOI：
10.1097/mpg.0b013e31826f2760
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发表时间：
2013-01-01
影响因子：
2.9
通讯作者：
Dhawan, Anil
中科院分区：
文献类型：
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作者：
Fitzpatrick, Emer;Quaglia, Alberto;Dhawan, Anil
背景：儿童肝病的预后主要取决于肝纤维化的严重程度和进展。肝活检是评估纤维化的公认标准，但受到儿童镇静需要、取样误差和出血风险的限制。本研究的目的是比较无创评估的工具，肝纤维化在儿科cohol.Methods：儿童接受肝活检慢性肝病招募和接受瞬时弹性成像（TE）。由肝组织病理学家对肝活检进行评分，从F0（无纤维化）至F4（肝硬化）。TE与活检score.Results比较：在研究期间，104名儿童（62名男孩）入组（中位年龄13.6岁）。诊断为自身免疫性肝病27例，非酒精性脂肪性肝病37例，移植后16例，B/C型肝炎8例，威尔逊病5例，其余为其他疾病。除7例患者外，所有患者的TE均成功，并且是显著纤维化（>= F2）（P < 0.001）、重度纤维化（>= F3）（P < 0.001）和肝硬化（F4）（P <0.003）的良好分类。使用TE预测>= F2、>= F3和F4的受试者工作特征曲线下面积分别为0.78、0.79和0.96。TE表现最好的儿童自身免疫性肝病和那些posttransplant.Conclusions：本研究表明，TE是一个可靠的工具，在区分不同阶段的肝纤维化的儿科患者。因此，TE可以作为一个有用的辅助肝活检的诊断目的提供了一个可靠的方法，无创监测儿童肝脏疾病的进展。
Background: Outcome of liver disease in children is mainly determined by severity and progression of liver fibrosis. Liver biopsy is the accepted standard for evaluating fibrosis but is limited by the need for sedation in children, sampling error, and risks including bleeding. The aim of the present study was to compare tools for noninvasive assessment of liver fibrosis in a paediatric cohort.Methods: Children undergoing liver biopsy for chronic liver disease were recruited and underwent transient elastography (TE). Liver biopsies were scored by a hepatohistopathologist from F0 (no fibrosis) to F4 (cirrhosis). TE was compared with biopsy score.Results: During the study period, 104 children (62 boys) were enrolled (median age 13.6 years). Diagnosis was autoimmune liver disease in 27; nonalcoholic fatty liver disease in 37; posttransplant in 16; hepatitis B/C in 8; Wilson disease in 5; and the remainder, miscellaneous. TE was successful in all but 7 patients and was a good discriminator of significant fibrosis (>= F2) (P < 0.001), severe fibrosis (>= F3) (P < 0.001), and cirrhosis (F4) (P 0.003). The area under the receiver operating characteristic curve for the prediction of >= F2, >= F3, and F4 using TE was 0.78, 0.79, and 0.96, respectively. TE performed best in children with autoimmune liver disease and in those posttransplant.Conclusions: The present study demonstrates that TE is a reliable tool in distinguishing different stages of liver fibrosis in paediatric patients. Thus, TE may serve as a useful adjunct to liver biopsy for diagnostic purposes providing a reliable method of noninvasively monitoring liver disease progression in children.