Hong Charles R, Han Sam M, Staffa Steven J, Carey Alexandra N, Lee Christine K, Modi Biren P
Center for Advanced Intestinal Rehabilitation; Boston Children's Hospital, Boston, MA; Department of Surgery; Boston Children's Hospital and Harvard Medical School, Boston, MA.
Department of Surgery; Boston Children's Hospital and Harvard Medical School, Boston, MA.
J Pediatr Surg. 2019 Jun;54(6):1174-1178. doi: 10.1016/j.jpedsurg.2019.02.038. Epub 2019 Mar 1.
The purpose of this study was to evaluate the diagnostic utility of noninvasive Vibration-Controlled Transient Elastography (VCTE) for assessing liver fibrosis in pediatric intestinal failure (PIF) patients.
Data from children with severe intestinal failure (≥90 days parenteral nutrition dependence) who underwent liver stiffness measurement (LSM), as measured by VCTE, at our institution between December 2015 and March 2018 were reviewed. LSM was compared to METAVIR fibrosis score (F0-F4) on liver biopsy performed within 1 year of VCTE.
Seventy children underwent 75 LSM. Sixty-three patients (38% female) had at least one valid LSM, and 63% had a history of cholestasis (direct bilirubin ≥2 mg/dL). Median (IQR) age at first valid LSM was 4.5 years (2.6, 8.7). Sixteen patients had a liver biopsy. LSM differentiated between METAVIR F0-F1 (n = 6) and F2-F4 (n = 10) with an area under the receiver operating characteristic (AUROC) curve of 0.883 (95% CI: 0.686-0.999). The optimal cut-point derived to predict F2-F4 was an LSM ≥6 kPa (sensitivity 80%, specificity 100%).
LSM as determined by VCTE can distinguish mild (F0-F1) from moderate/severe (F2-F4) liver fibrosis in PIF. VCTE could allow for serial noninvasive monitoring of liver injury, potentially facilitating timely modifications to hepatoprotective management.
Study of Diagnostic Test.
II.
本研究旨在评估无创振动控制瞬时弹性成像（VCTE）在评估小儿肠衰竭（PIF）患者肝纤维化方面的诊断效用。
回顾了2015年12月至2018年3月期间在我院接受VCTE测量肝脏硬度值（LSM）的严重肠衰竭（肠外营养依赖≥90天）患儿的数据。将LSM与VCTE后1年内进行的肝活检的METAVIR纤维化评分（F0-F4）进行比较。
70名儿童接受了75次LSM测量。63例患者（38%为女性）至少有一次有效的LSM测量，63%有胆汁淤积病史（直接胆红素≥2mg/dL）。首次有效LSM测量时的中位（IQR）年龄为4.5岁（2.6，8.7）。16例患者进行了肝活检。LSM在区分METAVIR F0-F1（n = 6）和F2-F4（n = 10）时，受试者操作特征（AUROC）曲线下面积为0.883（95%CI：0.686-0.999）。预测F2-F4的最佳切点为LSM≥6 kPa（敏感性80%，特异性100%）。
VCTE测定的LSM可区分PIF患者轻度（F0-F1）与中度/重度（F2-F4）肝纤维化。VCTE可对肝损伤进行系列无创监测，可能有助于及时调整肝脏保护管理措施。
诊断试验研究。
II级。
