Paediatric Liver, GI and Nutrition Centre, King's College London School of Medicine at King's College Hospital, London, UK.
J Pediatr Gastroenterol Nutr. 2013 Jan;56(1):72-6. doi: 10.1097/MPG.0b013e31826f2760.
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.
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.
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.
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.
儿童肝病的预后主要取决于肝纤维化的严重程度和进展情况。肝活检是评估纤维化的公认标准，但受到儿童镇静、取样误差和出血等风险的限制。本研究旨在比较非侵入性评估儿童肝纤维化的工具。
招募因慢性肝病而行肝活检的儿童，并进行瞬时弹性成像（TE）检查。由肝组织病理学家对肝活检进行评分，范围从 F0（无纤维化）到 F4（肝硬化）。将 TE 与活检评分进行比较。
在研究期间，共纳入 104 名儿童（62 名男性）（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；乙型/丙型肝炎 8 例；Wilson 病 5 例；其余为其他疾病。除 7 例外，所有患者均成功进行 TE 检查，TE 可很好地区分显著纤维化（≥ F2）（P < 0.001）、严重纤维化（≥ F3）（P < 0.001）和肝硬化（F4）（P = 0.003）。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 在自身免疫性肝病和移植后患者中表现最佳。
本研究表明，TE 是一种可靠的工具，可区分儿科患者不同阶段的肝纤维化。因此，TE 可能作为肝活检的有用辅助手段，为诊断目的提供一种可靠的方法，可用于非侵入性监测儿童肝病的进展。
