Raizner Aileen, Shillingford Nick, Mitchell Paul D, Harney Sarah, Raza Roshan, Serino Jessica, Jonas Maureen M, Lee Christine K
*Division of Gastroenterology, Hepatology, and Nutrition, Phoenix Children's Hospital, Phoenix, AZ †Pathology and Laboratory Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles ‡Clinical Research Center §Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA.
J Pediatr Gastroenterol Nutr. 2017 Apr;64(4):512-517. doi: 10.1097/MPG.0000000000001376.
Transient elastography (TE) measures liver stiffness to assess fibrosis. Studies in adults have shown that inflammation increases stiffness, leading to an overestimation of fibrosis. We investigated the contribution of inflammation to liver stiffness measurements (LSMs) in children/young adults.
This was a cohort analysis of children/young adults who underwent TE within 1 year of liver biopsy. Alanine aminotransferase (ALT) was obtained within 30 days of the biopsy and LSM. Fibrosis was assessed by METAVIR stage and inflammation by ALT and Ishak score. Data were stratified into METAVIR F0-F2 versus F3-F4. Change between ALT and LSM over time was also assessed.
A total of 154 patients (50% male patients) ages 3 weeks to 24 years (18% <3 years) were studied. Diagnoses included autoimmune (N = 38, 25%), viral (N = 25, 16%), cholestasis (N = 17, 11%), fatty liver (N = 9, 6%), biliary atresia (N = 8, 5%), metabolic (N = 5, 3%), allograft rejection (N = 4, 3%), and other (N = 48, 31%). Thirty-four percent of patients had F3-F4. In patients with F0-F2, the proportion of those with LSM >8.6 kPa increased with increasing ALT (P = 0.002). In patients with F3-F4, there was no association between ALT and LSM (P = 0.17). A correlation between change in ALT and LSM was observed in patients with no/minimal fibrosis and inflammatory liver diseases (r = 0.33).
In children with no/minimal hepatic fibrosis and inflammatory liver disease, high ALT values are associated with LSM in the range typical of advanced fibrosis. However, with more advanced fibrosis, inflammation does not appear to contribute to LSM. Caution must be taken when interpreting LSM for assessing fibrosis severity in the setting of inflammation.
瞬时弹性成像（TE）通过测量肝脏硬度来评估肝纤维化。针对成年人的研究表明，炎症会增加肝脏硬度，从而导致对肝纤维化的高估。我们调查了炎症对儿童/青年肝脏硬度测量值（LSM）的影响。
这是一项对在肝活检后一年内接受TE检查的儿童/青年进行的队列分析。在活检和LSM检查的30天内获取丙氨酸氨基转移酶（ALT）水平。根据METAVIR分期评估肝纤维化程度，根据ALT和Ishak评分评估炎症程度。数据被分为METAVIR F0 - F2组和F3 - F4组。同时还评估了ALT和LSM随时间的变化情况。
共研究了154例患者（50%为男性），年龄在3周至24岁之间（18%小于3岁）。诊断包括自身免疫性疾病（N = 38，25%）、病毒性疾病（N = 25，16%）、胆汁淤积（N = 17，11%）、脂肪肝（N = 9，6%）、胆道闭锁（N = 8，5%）、代谢性疾病（N = 5，3%）、同种异体移植排斥反应（N = 4，3%）以及其他疾病（N = 48，31%）。34%的患者为F3 - F4期。在F0 - F2期患者中，LSM > 8.6 kPa的患者比例随ALT升高而增加（P = 0.002）。在F3 - F4期患者中，ALT与LSM之间无关联（P = 0.17）。在无/轻度肝纤维化和炎症性肝病患者中，观察到ALT变化与LSM之间存在相关性（r = 0.33）。
在无/轻度肝纤维化和炎症性肝病的儿童中，高ALT值与处于晚期纤维化典型范围内的LSM相关。然而，对于更严重的肝纤维化，炎症似乎对LSM没有影响。在炎症情况下解释LSM以评估纤维化严重程度时必须谨慎。
