Medical School of Chinese PLA, Beijing, China.
Department of Liver Disease of Chinese, Fifth Medical Center of Chinese, PLA General Hospital, PLA General Hospital, Beijing, China.
Hepatol Int. 2021 Jun;15(3):602-610. doi: 10.1007/s12072-021-10194-7. Epub 2021 Jul 9.
This study aimed to compare the diagnostic accuracy of transient elastography (TE) and biopsy for the detection of liver fibrosis in children with chronic hepatitis B (CHB).
This single-center prospective study included 157 CHB children aged 0-6 years. All patients underwent liver stiffness measurement (LSM) by TE and liver biopsy, separated by an interval of less than 1 week.
The LSM, aspartate aminotransferase-platelet ratio index (APRI), and fibrosis-4 index (FIB-4) were positively correlated with activity grade and fibrosis stage in CHB children. The areas under the receiver operating characteristic curves (AUCs) of LSM for identifying significant (F ≥ 2) and advanced (F ≥ 3) fibrosis were 0.732 and 0.941, respectively. The cut-off values, specificity, and sensitivity for significant fibrosis were 5.6 kPa, 75.7%, and 67.4%, respectively; the corresponding values for advanced fibrosis were 6.9 kPa, 91.5%, and 81.3%, respectively. Compared to LSM, the overall diagnostic performances of APRI and FIB-4 for significant and advanced fibrosis were suboptimal, with low AUCs and sensitivity. Since LSM, platelet, and Log (hepatitis B surface antigen) were independent factors associated with the fibrosis stage (F < 2 and F ≥ 2), they were used to formulate the "LPS" index for the prediction of F ≥ 2. The AUC of LPS (for F ≥ 2) was higher than that of LSM (0.792 vs. 0.732, p < 0.05), and had an improved sensitivity (76.6% vs. 67.4%).
TE is a promising technology for the diagnosis of advanced fibrosis in CHB children aged 0-6 years.
本研究旨在比较瞬时弹性成像（TE）和肝活检在诊断慢性乙型肝炎（CHB）儿童肝纤维化中的诊断准确性。
这项单中心前瞻性研究纳入了 157 名 0-6 岁的 CHB 儿童。所有患者均在 1 周内先后接受 TE 肝硬度测量（LSM）和肝活检。
CHB 儿童的 LSM、天冬氨酸氨基转移酶-血小板比值指数（APRI）和纤维化-4 指数（FIB-4）与活动度分级和纤维化分期呈正相关。LSM 鉴别显著（F≥2）和进展性（F≥3）纤维化的受试者工作特征曲线（ROC）下面积（AUC）分别为 0.732 和 0.941。显著纤维化的截断值、特异性和敏感性分别为 5.6kPa、75.7%和 67.4%；进展性纤维化的相应值分别为 6.9kPa、91.5%和 81.3%。与 LSM 相比，APRI 和 FIB-4 对显著和进展性纤维化的总体诊断性能不佳，AUC 和敏感性均较低。由于 LSM、血小板和 Log（乙型肝炎表面抗原）是与纤维化分期（F<2 和 F≥2）相关的独立因素，因此将它们用于制定用于预测 F≥2 的“LPS”指数。LPS（用于 F≥2）的 AUC 高于 LSM（0.792 比 0.732，p<0.05），且敏感性提高（76.6%比 67.4%）。
TE 是诊断 0-6 岁 CHB 儿童进展性纤维化的一种很有前途的技术。
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