瞬时弹性成像技术、APRI及FIB-4对胆道闭锁患儿肝纤维化程度的诊断价值

陈玮婷; 李双杰

doi:10.3969/j.issn.1001-5256.2020.03.015

瞬时弹性成像技术、APRI及FIB-4对胆道闭锁患儿肝纤维化程度的诊断价值

DOI: 10.3969/j.issn.1001-5256.2020.03.015

湖南省儿童医院肝病中心

详细信息

中图分类号: R725.7;R445.1
计量
- 文章访问数: 1263
- HTML全文浏览量: 44
- PDF下载量: 242
- 被引次数: 0
出版历程
- 出版日期: 2020-03-20

Clinical value of transient elastography,aspartate aminotransferase-to-platelet ratio index,and fibrosis-4 in the diagnosis of liver fibrosis in children with biliary atresia

Liver Research Center, Hunan Children’s Hospital

摘要

摘要: 目的探讨肝脏瞬时弹性成像技术检测肝脏硬度（LSM）、AST-PLT比值指数（APRI）、基于4因子的肝纤维化指数（FIB-4）对胆道闭锁患儿肝纤维化程度的诊断价值。方法选取2016年1月1日-2018年12月31日于湖南省儿童医院新生儿外科行Kasai术的胆道闭锁患儿110例。收集患儿术中肝脏病理活检标本及术前1周内血常规、肝功能、瞬时弹性成像检查结果。计数资料组间比较采用χ2检验,非正态分布的计量资料多组间比较采用Kruskal-Wallis H秩和检验。采用MedCalc软件绘制受试者工作特征曲线（ROC曲线）,通过ROC曲线评估瞬时弹性成像技术、APRI和FIB-4对胆道闭锁患儿肝纤维化程度的诊断效能。采用Spearman相关法进行相关性分析。结果 ROC曲线分析显示,LSM、APRI、FIB-4用于判断胆道闭锁明显肝纤维化（F≥2）的临界值分别为9. 250 kPa、0. 680、0. 047,ROC曲线下面积（AUC）分别为0. 874[95%可信区间（95%CI）:0. 778～0. 970]、0. 636（95%CI:0. 362～0. 911）、0...
- 胆道闭锁 /
- 肝硬化 /
- 弹性成像技术 /
- 天冬氨酸转氨酶-血小板比值指数 /
- FIB-4 /
- 诊断
Abstract: Objective To investigate the value of liver stiffness measurement( LSM) by transient elastography,aspartate aminotransferase-to-platelet ratio index( APRI),and fibrosis-4( FIB-4) in the diagnosis of liver fibrosis in children with biliary atresia. Methods A total of 110 children with biliary atresia who underwent Kasai operation in Department of Neonatal Surgery,Hunan Children's Hospital,from January 1,2016 to December 31,2018 were enrolled. Liver biopsy specimens and related clinical data were collected,including routine blood test results,liver function,and transient elastography results. The chi-square test was used for comparison of categorical data between groups. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data. MedCalc software was used to plot the receiver operating characteristic( ROC) curve,and the ROC curve was used to evaluate the diagnostic efficiency of LSM,APRI,and FIB-4 in evaluating the degree of liver fibrosis. The Spearman correlation analysis was also performed. Results The ROC curve analysis showed that in the diagnosis of biliary atresia with marked liver fibrosis( F≥2),LSM had an area under the ROC curve( AUC) of 0. 874( 95% confidence interval [CI]: 0. 778-0. 970) at the cut-off value of 9. 250 kPa,APRI had an AUC of 0. 636( 95% CI: 0. 362-0. 911) at the cut-off value of 0. 680,and FIB-4 had an AUC of 0. 622( 95% CI: 0. 363-0. 880) at the cut-off value of 0. 047; in the diagnosis of biliary atresia with progressive liver fibrosis( F≥3),LSM,APRI,and FIB-4 had an AUC of 0. 781( 95% CI: 0. 689-0. 873),0. 519( 95% CI: 0. 401-0. 636),and 0. 506( 95% CI: 0. 389-0. 623),respectively,at the cut-off value of 10. 75 k Pa,0. 70,and 0. 05,respectively; in the diagnosis of biliary atresia with liver cirrhosis( F≥4),LSM,APRI,and FIB-4 had an AUC of0. 855( 95% CI: 0. 769-0. 942),0. 701( 95% CI: 0. 599-0. 803),and 0. 717( 95% CI: 0. 609-0. 825),respectively,at the cut-off value of 11. 85 kPa,0. 82,and 0. 09,respectively. The correlation analysis showed that LSM was positively correlated with aspartate aminotransferase level( r = 0. 258,P = 0. 007) and was negatively correlated with platelet count( r =-0. 248,P = 0. 009). Conclusion Transient elastography has a high accuracy in determining the grade of liver fibrosis in children with biliary atresia,with a higher clinical value than APRI and FIB-4 in evaluating the degree of liver fibrosis.
- biliary atresia /
- liver cirrhosis /
- elasticity imaging techniques /
- APRI /
- FIB-4 /
- diagnosis

HTML全文

参考文献(23)

[1] SHNEIDER BL,MAGEE JC,KARPEN SJ,et al. Total serum bilirubin within 3 months of hepatoportoenterostomy predicts short-term outcomes in biliary atresia[J]. J Pediatr,2016,170(6):211-217.

[2] CHARDOT C,BUET C,SERINET MO,et al. Improving outcomes of biliary atresia:French national series 1986-2009[J]. J Hepatol,2013,58(6):1209-1217.

[3] CASTERA L. Assessing liver fibrosis[J]. Expert Rev Gastroenterol Hepatol,2008,2(4):541-552.

[4] LI J,GORDON SC,RUPP LB,et al. Long-term progression of viral load and serum markers of fibrosis among treated and untreated patients with chronic hepatitis B[J]. J Gastroenterol Hepatol,2017,32(6):1250-1257.

[5] OGAWA E,FURUSYO N,MURATA M,et al. Longitudinal assessment of liver stiffness by transient elastography for chronic hepatitis B patients treated with nucleoside analog[J]. Hepatol Res,2011,41(12):1178-1188.

[6] BEDOSSA P,POYNARD T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group[J]. Hepatology,1996,24(2):289-293.

[7] WAI CT,GREENSON JK,FONTANA RJ,et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C[J]. Hepatology,2003,38(2):518-526.

[8] STEERLING RK,LISSEN E,CLUMECK N,et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection[J]. Hepatology,2006,43(6):1317-1325.

[9] HARTLEY JL,DAVENPORT M,KELLY DA. Biliary atresia[J].Lancet,2009,374(9702):1704-1713.

[10] BAUMANN U,URE B. Biliary atresia[J]. Clin Res Hepatol Gastroenterol,2012,36(3):257-259.

[11] CHENG DY,WANG XM,OU WN,et al. Application of transient elastography in non-invasive diagnosis of liver fibrosis in patients with non-viral liver diseases[J/CD]. Chin J Liver Dis(Electronic Version),2019,11(1):37-41.(in Chinese)程丹颖，王笑梅，欧蔚妮，等．瞬时弹性成像技术在非病毒性肝病肝纤维化无创诊断中的应用[J/CD]．中国肝脏病杂志(电子版)，2019,11(1):37-41.

[12] Chinese Society of Hepatology,Chinese Medical Association;Chinese Society of Gastroenterology,Chinese Medical Association; Chinese Society of Infectious Diseases,Chinese Medical Association. Consensus on the diagnosis and therapy of hepatic fibrosis(2019)[J]. J Clin Hepatol,2019,35(10):2163-2172.(in Chinese)中华医学会肝病学分会，中华医学会消化病学分会，中华医学会感染病学分会．肝纤维化诊断及治疗共识(2019年)[J]．临床肝胆病杂志，2019,35(10):2163-2172.

[13] SHIN NY,KIM MJ,LEE MJ,et al. Transient elastography and sonography for prediction of liver fibrosis in infants with biliary atresia[J]. J Ultrasound Med,2014,33(5):853-864.

[14] BEHAIRY BEL-S,SIRA MM,ZALATA KR,et al. Transient elastography compared to liver biopsy and morphometry for predicting fibrosis in pediatric chronic liver disease:Does etiology matter?[J]. World J Gastroenterol,2016,22(16):4238-4249.

[15] SHEN QL,CHEN YJ,WANG ZM,et al. Assessment of liver fibrosis by Fibroscan as compared to liver biopsy in biliary atresia[J]. World J Gastroenterol,2015,21(22):6931-6936.

[16] PISCAGLIA F,SALVATORE V,MULAZZANI L,et al. Differences in liver stiffness values obtained with new ultrasound elastography machines and Fibroscan:A comparative study[J]. Dig Liver Dis,2017,49(7):802-808.

[17] GAO KK,CHEN ZR,PENG XF,et al. Evaluation of hepatic fibrosis using aspartate aminotransferase-to-platelet ratio index in children with biliary atresia[J]. Chin J Lab Med,2015,38(5):337-340.(in Chinese)高坎坎，陈峥嵘，彭小芳，等．APRI在评估婴儿胆道闭锁肝脏纤维化程度中的应用[J]．中华检验医学杂志，2015,38(5):337-340.

[18] HE XZ,ZHANG MM,LI YC,et al. Predictive value of aspartate aminotransferase-to-platelet ratio index on hepatic fibrosis progression in children with biliary atresia[J]. Chin J Pediatr Surg,2013,34(3):176-179.(in Chinese)贺小张，张明满，李英存，等．天冬氨酸转氨酶和血小板比值对胆道闭锁肝纤维化预测价值的研究[J]．中华小儿外科杂志，2013,34(3):176-179.

[19] VOUTILAINEN S,KIVISAARI R,LOHI J,et al. A prospective comparison of noninvasive methods in the assessment of liver fibrosis and esophageal varices in pediatric chronic liver diseases[J]. J Clin Gastroenterol,2016,50(8):658-663.

[20] CHEN S,LIAO B,ZHONG Z,et al. Supersonic shearwave elastography in the assessment of liver fibrosis for postoperative patients with biliary atresia[J]. Sci Rep,2016,27(6):31057.

[21] VINCIGUERRA T,BRUNATI A,DAVID E,et al. Transient elastography for non-invasive evaluation of post-transplant liver graft fibrosis in children[J]. Pediatr Transplant,2018,22(2):e13125.

[22] DAS K,SARKAR R,AHMED SM,et al．“Normal”liver stiffness measure(LSM)values are higher in both lean and obese individuals:A population-based study from a developing country[J]. Hepatology,2012,55(2):584-593.

[23] SASSO M,TENGHER-BARNA I,ZIOL M,et al. Novel controlled attenuation parameter for noninvasive assessment of steatosis using Fibroscan:Validation in chronic hepatitis C[J]. J Viral Hepat,2012,19(4):244-253.

施引文献

资源附件(0)

访问统计