超声剪切波弹性成像技术和 APRI 在小儿囊性纤维化肝病的检测和分期中的应用。
Supersonic shear-wave elastography and APRI for the detection and staging of liver disease in pediatric cystic fibrosis.
机构信息
Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, QLD 4006, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia.
Department of Gastroenterology and Hepatology, Queensland Children's Hospital, 501 Stanley St, South Brisbane, QLD, 4101, Australia.
出版信息
J Cyst Fibros. 2020 May;19(3):449-454. doi: 10.1016/j.jcf.2019.06.017. Epub 2019 Jul 11.
BACKGROUND
Current diagnostic methods for the diagnosis of Cystic fibrosis (CF)-associated liver disease (CFLD) are non-specific and assessment of disease progression is difficult prior to the advent of advanced disease with portal hypertension. This study investigated the potential of Supersonic shear-wave elastography (SSWE) to non-invasively detect CFLD and assess hepatic fibrosis severity in children with CF.
METHODS
125 children were enrolled in this study including CFLD (n = 55), CF patients with no evidence of liver disease (CFnoLD = 41) and controls (n = 29). CFLD was diagnosed using clinical, biochemical and imaging best-practice guidelines. Advanced CFLD was established by the presence of portal hypertension and/or macronodular cirrhosis on ultrasound. Liver stiffness measurements (LSM) were acquired using SSWE and diagnostic performance for CFLD detection was evaluated alone or combined with aspartate aminotransferase-to-platelet ratio index (APRI).
RESULTS
LSM was significantly higher in CFLD (8.1 kPa, IQR = 6.7-11.9) versus CFnoLD (6.2 kPa, IQR = 5.6-7.0; P < 0.0001) and Controls (5.3 kPa, IQR = 4.9-5.8; P < 0.0001). LSM was also increased in CFnoLD versus Controls (P = 0.0192). Receiver Operating Characteristic (ROC) curve analysis demonstrated good diagnostic accuracy for LSM in detecting CFLD using a cut-off = 6.85 kPa with an AUC = 0.79 (Sensitivity = 75%, Specificity = 71%, P < 0.0001). APRI also discriminated CFLD (AUC = 0.74, P = 0.004). Classification and regression tree modelling combining LSM + APRI showed 14.8 times greater odds of accurately predicting CFLD (AUC = 0.84). The diagnostic accuracy of SSWE for discriminating advanced disease was excellent with a cut-off = 9.05 kPa (AUC = 0.95; P < 0.0001).
CONCLUSIONS
SSWE-determined LSM shows good diagnostic accuracy in detecting CFLD in children, which was improved when combined with APRI. SSWE alone discriminates advanced CFLD.
背景
目前，囊性纤维化（CF）相关肝病（CFLD）的诊断方法是非特异性的，并且在出现门静脉高压等晚期疾病之前，很难评估疾病的进展情况。本研究旨在探讨超声剪切波弹性成像（SSWE）在诊断 CF 儿童 CFLD 及评估肝纤维化严重程度方面的潜在应用。
方法
本研究共纳入 125 名儿童，包括 CFLD 组（n=55）、无肝疾病证据的 CF 患者（CFnoLD，n=41）和对照组（n=29）。采用临床、生化和影像学最佳实践指南诊断 CFLD。采用超声检查诊断门静脉高压和/或大结节性肝硬化确立晚期 CFLD。采用 SSWE 检测肝脏硬度值（LSM），评估 LSM 单独或与天门冬氨酸氨基转移酶与血小板比值指数（APRI）联合诊断 CFLD 的性能。
结果
CFLD 组 LSM 显著高于 CFnoLD 组（8.1kPa，IQR=6.7-11.9）和对照组（5.3kPa，IQR=4.9-5.8；P<0.0001），CFnoLD 组也高于对照组（P=0.0192）。ROC 曲线分析显示，LSM 以 6.85kPa 为截断值诊断 CFLD 的诊断准确性较高，AUC=0.79（敏感度=75%，特异度=71%，P<0.0001）。APRI 也能区分 CFLD（AUC=0.74，P=0.004）。联合 LSM+APRI 的分类回归树模型显示，准确预测 CFLD 的可能性增加了 14.8 倍（AUC=0.84）。SSWE 以 9.05kPa 为截断值诊断晚期疾病的诊断准确性极佳（AUC=0.95，P<0.0001）。
结论
SSWE 测定的 LSM 在诊断 CF 儿童 CFLD 方面具有较好的诊断准确性，与 APRI 联合应用可提高诊断准确性。SSWE 可单独区分晚期 CFLD。
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