From the Departments of Pediatric Hepatology and Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India.
J Pediatr Gastroenterol Nutr. 2023 Mar 1;76(3):364-370. doi: 10.1097/MPG.0000000000003674. Epub 2022 Dec 1.
We studied splenic stiffness measurement (SSM) by transient elastography (TE) and portal hemodynamics parameters (PHDp) on Doppler as predictors of clinically significant varices (CSV) in children.
All children of 6 months to 18 years of age with portal hypertension (PHT) (chronic liver disease, CLD and non-cirrhotic portal hypertension, NCPH) were enrolled. TE for spleen (SSM) and liver (liver stiffness measurement, LSM) and PHDp by Doppler ultrasonography were measured. Noninvasive indices for PHT were calculated. CSV were defined as esophageal varices ≥grade 2 and/or gastric varix. Binary logistic regression analysis (LRA) and receiver operating characteristic statistics were applied.
A total of 150 (120 CLD and 30 NCPH) children formed the study cohort. Prevalence of CSV was higher in NCPH than CLD [73.3% vs 53.3%, Odd's ratio (OR) 2.369, P = 0.04]. On LRA, SSM was found to be the only independent predictor of CSV in children with CLD [OR 1.19 (95% Confidence Interval (CI) 1.018-1.16), P = 0.000] as well as in NCPH [OR 1.088 (95% CI 1.018-1.16), P = 0.013]. This model improved prediction of CSV in CLD from 52.5% to 83.9% and in NCPH from 73.3% to 86.7%. In children with CLD, SSM at a cut-off ≥27.6 kPa and in NCPH, SSM at a cut-off ≥29.5 kPa predicted CSV. In children with CLD, SSM correlated with LSM ( R = 0.610, P <0.001) and with noninvasive PHT indices except aspartate aminotransferase-to-platelet ratio index.
SSM is the best noninvasive predictor of CSV in childhood CLD and NCPH and can be used as screening test for endoscopy in children with PHT.
我们研究了瞬时弹性成像（TE）测量的脾脏硬度（SSM）和多普勒超声门静脉血流动力学参数（PHDp），以预测儿童的临床显著静脉曲张（CSV）。
所有 6 个月至 18 岁患有门静脉高压症（PHT）（慢性肝病，CLD 和非肝硬化性门静脉高压症，NCPH）的儿童均被纳入研究。进行 TE 测量脾脏（SSM）和肝脏（肝脏硬度测量，LSM）以及多普勒超声门静脉血流动力学参数（PHDp）。计算非侵入性 PHT 指标。将食管静脉曲张≥2 级和/或胃静脉曲张定义为 CSV。应用二元逻辑回归分析（LRA）和受试者工作特征统计。
共 150 名（120 名 CLD 和 30 名 NCPH）儿童组成研究队列。NCPH 中 CSV 的患病率高于 CLD [73.3%比 53.3%，优势比（OR）2.369，P = 0.04]。在 LRA 中，SSM 被发现是 CLD 儿童 CSV 的唯一独立预测因子[OR 1.19（95%置信区间（CI）1.018-1.16），P = 0.000]以及 NCPH [OR 1.088（95% CI 1.018-1.16），P = 0.013]。该模型将 CLD 中 CSV 的预测从 52.5%提高到 83.9%，将 NCPH 中 CSV 的预测从 73.3%提高到 86.7%。在 CLD 儿童中，SSM 截断值≥27.6kPa，在 NCPH 中，SSM 截断值≥29.5kPa 可预测 CSV。在 CLD 儿童中，SSM 与 LSM 相关（R = 0.610，P <0.001），与除天冬氨酸转氨酶/血小板比值指数外的非侵入性 PHT 指数相关。
SSM 是儿童 CLD 和 NCPH 中 CSV 的最佳非侵入性预测因子，可作为 PHT 儿童内镜检查的筛查试验。
