Awad Mohiee El-Deen Abd El-Aziz, Shiha Gamal Elsayed, Sallam Fersan Abdallah, Mohamed Amany, El Tawab Abd
J Egypt Soc Parasitol. 2013 Dec;43(3):805-19.
The study evaluated liver stiffness measurement (LSM) using non-invasive transient elastography (TE) in comparison with liver biopsy for assessment of hepatic fibrosis in children with chronic hepatitis C (CHC). Thirty children (mean age 10.13 +/- 3.4 years) with CHC were subjected to histopathological assessment of liver biopsy specimens using METAVIER score and LSM using TE (FibroScan) as well as appropriate laboratory investigations. The results showed a highly significant stepwise increase of the mean liver stiffness values with increasing histological severity of hepatic fibrosis with the highest level detected in patients with stage F4 "cirrhosis" and significant differences for F3 and F4 vs. other fibrosis stages. There were significant positive correlations between LSM and several parameters of activity and progression of the chronic liver disease including METAVIER fibrosis stages (r=0.774, p=0.0001), necroinflammatory activity grades, AST, ALT, total serum bilirubin, prothrombin time and Child-Pugh grades as well as biochemical serum fibrosis markers (Fibrotest, Actitest, AST-to-platelet ratio index, Forns index and hyaluronic acid). The variables significantly negatively associated with the LSM were platelets count and serum albumin. The highest predictive performance of LSM was detected for stage F4 "cirrhosis", followed by F3 "advanced fibrosis" where accuracy of(96.7%, 85.3%) and AUROC of (1.00, 0.815) were obtained for these fibrosis stages at cutoff values of 9.5 and 12.5 kPa, respectively. The negative predictive values to exclude advanced fibrosis and cirrhosis at these cutoffs were high, whereas positive predictive values were modest.
该研究评估了使用非侵入性瞬时弹性成像（TE）测量肝脏硬度（LSM），并与肝活检进行比较，以评估慢性丙型肝炎（CHC）儿童的肝纤维化情况。30名CHC儿童（平均年龄10.13±3.4岁）接受了肝活检标本的组织病理学评估（使用METAVIER评分）、使用TE（FibroScan）测量LSM以及适当的实验室检查。结果显示，随着肝纤维化组织学严重程度的增加，平均肝脏硬度值呈高度显著的逐步升高，在F4期“肝硬化”患者中检测到的水平最高，F3和F4期与其他纤维化阶段存在显著差异。LSM与慢性肝病的几个活动和进展参数之间存在显著正相关，包括METAVIER纤维化阶段（r = 0.774，p = 0.0001）、坏死性炎症活动分级、AST、ALT、总血清胆红素、凝血酶原时间和Child-Pugh分级以及生化血清纤维化标志物（Fibrotest、Actitest、AST与血小板比值指数、Forns指数和透明质酸）。与LSM显著负相关的变量是血小板计数和血清白蛋白。LSM对F4期“肝硬化”的预测性能最高，其次是F3期“晚期纤维化”，在截断值分别为9.5和12.5 kPa时，这些纤维化阶段的准确率分别为（96.7%，85.3%），曲线下面积（AUROC）分别为（1.00，0.815）。在这些截断值下排除晚期纤维化和肝硬化的阴性预测值较高，而阳性预测值适中。
