Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, India.
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Eur J Pediatr. 2020 Apr;179(4):671-677. doi: 10.1007/s00431-019-03561-y. Epub 2020 Jan 21.
The objectives of this prospective case-control study were to determine liver stiffness (LSM) by transient elastography (TE) in children with newly diagnosed chronic liver disease (CLD) and to find out normal values in healthy Indian children. Two groups (A: 50 CLD who underwent liver biopsy and B: 50 healthy) aged 5-18 years were recruited prospectively. Liver biopsies were scored as per Metavir scoring and compared with TE. The median age of 100 recruited children was 13.6 years. In group B, normal LSM was 4.9 (2.5-7.3) kPa with significantly higher LSM in adolescent males (5.6 (4.1-7.3) kPa) as compared with females (4.3 (3.7-4.9) kPa), p = 0.001. In group A, TE was excellent in discriminating significant fibrosis (≥ F2) (P = 0.001) at a cut-off value of 10.6 kPa with area under receiver operating characteristic curve of 0.96. Metavir fibrosis stage (β = 0.611; R2 = 0.586) and age (β = 0.230; R2 = 0.586) were independent variables associated with higher LSM in stepwise multiple logistic regression analysis.Conclusions: TE is an excellent non-invasive tool to assess significant liver fibrosis and can be used as an alternative to liver biopsy. Normative value of TE in adolescent males is higher than in females.What is Known:• Transient elastography is a good non-invasive test for liver fibrosis assessment.• Normal liver stiffness depends on race, gender, and age.What is New:• This is the first study from India to show the normative data of transient elastography in healthy Indian children.• We have documented that liver stiffness measurement by fibroscan in treatment naïve chronic liver disease has excellent correlation in significant fibrosis, severe fibrosis, and cirrhosis.
本前瞻性病例对照研究的目的是通过瞬时弹性成像（TE）测定新诊断为慢性肝病（CLD）的儿童的肝硬度（LSM），并确定印度健康儿童的正常值。前瞻性招募了两组年龄在 5-18 岁的儿童：A 组（50 例接受肝活检的 CLD 患儿）和 B 组（50 例健康对照）。根据 Metavir 评分对肝活检进行评分，并与 TE 进行比较。100 名入组儿童的中位年龄为 13.6 岁。在 B 组中，正常 LSM 为 4.9（2.5-7.3）kPa，青少年男性的 LSM 明显高于女性（5.6（4.1-7.3）kPa），p=0.001。在 A 组中，TE 在区分显著纤维化（≥F2）方面表现出色（P=0.001），截断值为 10.6 kPa，ROC 曲线下面积为 0.96。多元逐步逻辑回归分析显示，Metavir 纤维化分期（β=0.611；R2=0.586）和年龄（β=0.230；R2=0.586）是与 LSM 升高相关的独立变量。结论：TE 是一种评估显著肝纤维化的优秀非侵入性工具，可替代肝活检。青少年男性的 TE 正常值高于女性。已知：• 瞬时弹性成像（TE）是一种评估肝纤维化的良好非侵入性检测方法。• 正常的肝硬度取决于种族、性别和年龄。新发现：• 这是印度的第一项研究，显示了印度健康儿童的瞬时弹性成像正常值。• 我们已经证明，在未经治疗的慢性肝病患者中，肝硬度测量值与显著纤维化、严重纤维化和肝硬化具有良好的相关性。
