联合弹性成像评估儿童肝纤维化

Combi-elasto for evaluating liver fibrosis in children

目的观察联合弹性成像(CE)评估儿童肝纤维化的价值。方法纳入76例S1~S4级肝纤维化患儿,比较各级之间一般资料、常规超声、CE及实验室指标,分析上述指标评估肝纤维化分级的效能。结果各级肝纤维化患儿之间,年龄、身高、体质量、肝脏回声、杨氏模量(E)、A指数(AI)、F指数(FI)、总胆红素、谷氨酰转肽酶、总蛋白、高密度脂蛋白(HDL)及甘油三酯差异均有统计学意义(P均<0.05),且上述指标均与肝纤维化分级低度相关(0.20≤│r│<0.50,P均<0.05);S4级患儿E及FI显著大于S1及S2级(P均<0.05),S3级患儿FI显著大于S2级(P<0.05)。肝脏回声、E、FI、总胆红素及甘油三酯为肝纤维化分级的影响因素。联合模型1(E+FI)、2(总胆红素+甘油三酯)、3(肝脏回声+E+FI+总胆红素+甘油三酯)、4(年龄+身高+体质量+肝脏回声+E+AI+FI+总胆红素+谷氨酰转肽酶+总蛋白+HDL+甘油三酯)评估肝纤维化分级≥S2的AUC分别为0.66、0.73、0.76及0.88,≥S3的AUC分别为0.81、0.84、0.93及0.95,≥S4分别为0.85、0.65、0.88及0.92。结论CE可用于评估儿童肝纤维化程度;联合实验室检查及常规超声可提高评估效能。

Objective To observe the value of combi-elasto(CE)for evaluating liver fibrosis in children.Methods Seventy-six children with S1—S4 grade liver fibrosis were enrolled.The general data,routine ultrasound,CE and laboratory indexes were compared among children with different grade liver fibrosis,and the efficacy of above indexes for evaluating the degree of liver cirrhosis were analyzed.Results There were significant differences of age,height,body mass,liver echo,Young's modulus(E),activity index(AI),fibrosis index(FI),total bilirubin,glutamyltranspeptidase,total protein,high-density lipoprotein(HDL)and triglyceride among children with different grade liver fibrosis(all P<0.05),and the above indexes were lowly correlated with grade of liver fibrosis(0.20≤│r│<0.50,all P<0.05).E and FI of S4 grade children were significantly higher than those of S1 and S2 grade children(both P<0.05),and FI of S3 grade children was significantly higher than that of S2 grade children(P<0.05).Liver echo,E,FI,total bilirubin and triglyceride were the impact factors of liver fibrosis.The area under the curve of combined model 1(E+FI),2(total bilirubin+triglyceride),3(liver echo+E+FI+total bilirubin+triglyceride)and 4(age+height+body mass+liver echo+E+AI+FI+total bilirubin+glutamyltranspeptidase+total protein+HDL+triglyceride)for evaluating liver fibrosis≥S2 grade was 0.66,0.73,0.76 and 0.88,for≥S3 was 0.81,0.84,0.93 and 0.95,for≥S4 was 0.85,0.65,0.88 and 0.92,respectively.Conclusion CE could effectively evaluate the degree of liver fibrosis in children.Combining with laboratory examination and routine ultrasound could improve the efficiency of evaluation.