应用瞬时弹性成像评估慢性肝病儿童肝纤维化程度

Application of transient elastography in assessing hepatic fibrosis in pediatric chronic liver disease

目的了解瞬时弹性成像(TE)在评估慢性肝病儿童肝纤维化程度中的应用。方法纳入2017年1月至9月在复旦大学附属儿科医院同时进行TE和经皮肝穿刺以进行Scheuer评分的慢性肝病患儿。采用有序Logistic回归分析肝纤维化分级的影响因素,采用受试者工作特征曲线(ROC)分析TE对肝纤维化分级的最佳截断值及曲线下面积(AUC)。结果共纳入38例患儿,男28例,女10例,平均年龄7.4岁(1.1~16.0岁),检测成功率为85%。有序Logistic回归显示,仅肝硬度值与肝纤维化分级相关(β=0.055,P<0.001)。TE能有效区分肝纤维化[<S2比≥S2(6.6±4.0)kPa比(21.2±18.6)kPa,P=0.001]、显著肝纤维化[<S3比≥S3(7.4±4.0)kPa比(34.8±19.0)kPa,P=0.0001]及肝硬化[<S4比S4(10.6±12.3)kPa比(35.8±15.1)kPa,P=0.002]。肝硬度截断值6.89 kPa、14.39 kPa分别预测肝纤维化分级≥S2及≥S3的AUC分别为0.81(P=0.001)、0.94(P<0.001)。结论TE是评估慢性肝病儿童肝纤维化程度的无创、有效及可靠的方法。

Objective To assess the transient elastography(TE)in assessing hepatic fibrosis in pediatric chronic liver disease.Methods Children with chronic liver disease who were both examined with TE and percutaneous transhepatic puncture for grading Scheuer scores in the Children′s Hospital of Fudan University from January 2017 to September 2017 were recruited.Ordinal Logistic regression analysis was used to analyze the interfering factors for hepatic fibrosis.Receiver operating characteristic(ROC)curves were plotted to acquire the optimal cut-off value and to calculate the area under the curve(AUC).Results Thirty-eight children were enrolled finally,including 28 boys and 10 girls with the mean age of 7.4 years old(1.1-16.0 years).The success rate of detecting hepatic fibrosis was 85%.Ordinal Logistic regression analysis discovered that only the value of liver stiffness measured by TE was correlated with the grade of hepatic fibrosis(β=0.055,P<0.001).TE was effective to differentiate hepatic fibrosis[<S2 vs.≥S2(6.6±4.0)kPa vs.(21.2±18.6)kPa,P=0.001],significant hepatic fibrosis[<S3 vs.≥S3(7.4±4.0)kPa vs.(34.8±19.0)kPa,P=0.0001,and cirrhosis[<S4 vs.S4(10.6±12.3)kPa vs.(35.8±15.1)kPa,P=0.002].At the cut-off values of liver stiffness measurement with 6.89 kPa and 14.39 kPa,AUC of it to predict the grade of hepatic fibrosis≥S2 and≥S3 were 0.81(P=0.001)and 0.94(P<0.001),respectively.Conclusions TE is a useful and reliable noninvasive tool to assess hepatic fibrosis in pediatric chronic liver disease.