儿童瞬时弹性成像测量的百分位数 - 年龄、性别、体重状况和青春期阶段的影响。
Pediatric percentiles for transient elastography measurements - effects of age, sex, weight status and pubertal stage.
机构信息
Center for Pediatric Research, University Hospital for Children and Adolescents, Leipzig, Germany.
Clinic and Polyclinic for Cardiology, Leipzig University Medical Center, Leipzig, Germany.
出版信息
Front Endocrinol (Lausanne). 2022 Sep 27;13:1030809. doi: 10.3389/fendo.2022.1030809. eCollection 2022.
BACKGROUND AND AIMS
Transient Elastography is a non-invasive, cost-efficient, non-ionizing, observer-independent and reliable method to detect liver fibrosis using Liver Stiffness Measurement (LSM) and the degree of fat accumulation in the liver using Controlled Attenuation Parameter (CAP). This study aims to derive reference values for both measures from healthy children and adolescents. Further, we aim to assess the potential influence of age, sex, puberty, and BMI-SDS on CAP and LSM.
METHODS
Within the LIFE Child study, amongst others, anthropometric data and pubertal status were assessed. Transient Elastography (TE) was performed using the FibroScan device in a population-based cohort at 982 study visits of 482 healthy children aged between 10 and 18 years. Percentiles for LSM and CAP were estimated, and the effects of age, sex, puberty and weight status were assessed through hierarchical regression models.
RESULTS
There was a strong age dependency for LSM with higher values for older children, most pronounced in the upper percentiles in boys. Contrarily, CAP was relatively stable across the age span without considerable difference between boys and girls. We found a significant positive correlation between BMI-SDS and both CAP and LSM for BMI-SDS >1.28. For BMI-SDS < 1.28, the association was also positive but reached statistical significance only for CAP. Further, the association between BMI-SDS and CAP was significantly stronger in younger than in older children. There was no association between pubertal status and CAP. For LSM, we found that children with a high BMI-SDS but not children with normal weight had significantly higher LSM values in Tanner stage 4.
CONCLUSIONS
Age, sex, pubertal status and weight status should be considered when interpreting LSM and CAP in pediatric patients to facilitate and improve early detection of abnormal liver function, which is associated with common pathologies, such as NAFLD.
背景与目的
瞬时弹性成像（Transient Elastography）是一种非侵入性、经济高效、非电离、观察者独立且可靠的方法，通过肝脏硬度测量（Liver Stiffness Measurement，LSM）和肝脏脂肪堆积程度的受控衰减参数（Controlled Attenuation Parameter，CAP）来检测肝纤维化。本研究旨在为健康儿童和青少年建立这两种方法的参考值，并进一步评估年龄、性别、青春期和 BMI-SDS 对 CAP 和 LSM 的潜在影响。
方法
在 LIFE Child 研究中，我们评估了儿童的人体测量数据和青春期状态。在一个基于人群的队列中，使用 FibroScan 设备在 482 名年龄在 10 至 18 岁之间的健康儿童的 982 次研究访问中进行了瞬时弹性成像（TE）。我们估计了 LSM 和 CAP 的百分位数，并通过分层回归模型评估了年龄、性别、青春期和体重状态的影响。
结果
LSM 与年龄密切相关，年龄较大的儿童的 LSM 值较高，男孩的最高百分位数更为明显。相反，CAP 在整个年龄段内相对稳定，男孩和女孩之间没有明显差异。我们发现 BMI-SDS 与 CAP 和 LSM 呈显著正相关，BMI-SDS>1.28。对于 BMI-SDS<1.28，相关性也是阳性的，但仅在 CAP 上达到统计学意义。此外，BMI-SDS 与 CAP 的相关性在年龄较小的儿童中明显强于年龄较大的儿童。青春期状态与 CAP 之间没有关联。对于 LSM，我们发现高 BMI-SDS 的儿童，而不是体重正常的儿童，在 Tanner 阶段 4 时 LSM 值显著更高。
结论
在儿科患者中解释 LSM 和 CAP 时，应考虑年龄、性别、青春期状态和体重状态，以促进和改善异常肝功能的早期检测，异常肝功能与常见疾病（如非酒精性脂肪性肝病）有关。
Zotero 插件