瞬时弹性成像技术对儿童肝纤维化的诊断价值研究

Diagnostic value of children with liver fibrosis by transient elastography

目的评估肝脏瞬时弹性成像技术对儿童肝纤维化的诊断价值。方法选择2015年1月1日至2018年12月31日在湖南省儿童医院住院治疗的慢性乙型病毒性肝炎患儿及2016年1月1日至2018年12月31日住院的胆道闭锁患儿共153例进行回顾性研究,收集瞬时弹性成像(transient elastography,TE)技术检测的肝硬度测定值(liver stiffness measurement,LSM)及患儿的临床资料。将患儿按以下分组方案进行分组:肝纤维化组(F≥1)和无肝纤维化组(F=0);明显肝纤维化组(F≥2)和无明显肝纤维化组(F<2);进展性肝纤维化组(F≥3)和非进展性肝纤维化组(F<3);肝硬化组(F=4)和非肝硬化组(F<4)。结果TE技术诊断肝纤维化的受试者工作特征曲线下面积(Area under the curve,AUC)为0.850,最佳截点值为7.4 kPa,灵敏度和特异度分别为79.86%、77.78%;诊断明显肝纤维化者AUC为0.864,最佳截点值为9.2 kPa,灵敏度和特异度分别为70.43%、84.21%;诊断进展性肝纤维化者AUC为0.840,最佳截点值为11.2 kPa,灵敏度和特异度分别为62.67%、93.59%;诊断肝硬化者AUC为0.894,最佳截点值为13.3 kPa,灵敏度和特异度分别为70.83%、91.47%。结论TE技术对儿童不同程度肝纤维化均有较好的诊断价值。

Objective To evaluate the diagnostic value of applying transient elastography for children with liver fibrosis.Methods Retrospective studies were conducted for 153 hospitalized children of chronic hepatitis B and biliary atresia admitted from January 1,2015 to December 31,2018 and from January 1,2016 to December 31,2018 respectively.The values of liver stiffness measurement(LSM)by transient elastography and their general profiles were collected.They were divided into liver fibrosis group(F≥1)and non-hepatic group(F=0);group with obvious liver fibrosis(F≥2)and group without obvious liver fibrosis(F<2);progressive liver fibrosis group(F≥3)and non-progressive liver fibrosis group(F<3);cirrhotic group(F=4)and non-cirrhotic group(F<4).Results The operating characteristic area under curve(AUC)of receiver with liver fibrosis diagnosed by transient elastography was 0.850,the optimal cut-off value 7.4 kpa and the sensitivity and the specificity 79.86%and 77.78%respectively.The AUC of children with obvious hepatic fibrosis was 0.864,the optimal cut-off value 9.2 kpa and the sensitivity and the specificity 70.43%and 84.21%respectively.The AUC of children with progressive hepatic fibrosis was 0.840,the optimal cut-off value 11.2 kpa and the sensitivity and the specificity 62.67%and 93.59%respectively.The AUC of children with cirrhosis was 0.894,the optimal cut-off value 13.3 kpa and the sensitivity and the specificity 70.83%and 91.47%respectively.Conclusion Transient elastography has an excellent application value in the diagnosis of different degrees of hepatic fibrosis in children.