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瞬时弹性成像对不同年龄慢性乙型肝炎肝纤维化患儿的诊断价值
Value of transient elastography in the diagnosis of liver fibrosis in chronic hepatitis B children of different ages
文章发布日期:2020年06月01日  来源:  作者:徐志强,董漪,王福川,等  点击次数:167次  下载次数:41次

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【摘要】:目的 评估瞬时弹性成像FibroScan对0~18岁不同年龄段儿童慢性乙型肝炎(CHB)肝纤维化的诊断价值。方法 选取解放军总医院第五医学中心2015年6月-2019年12月住院拟行抗病毒治疗的18岁以下的CHB患儿280例,其中学龄前儿童(≤6岁)157例、学龄儿童(6~12岁)74例、青少年(12~18岁)49例。3组均行肝穿刺病理检查评估肝纤维化程度,按Matevia评分分为轻度(0≤F<2)、中度(2≤F<3)、重度(F≥3),同时应用 FibroScan进行肝脏硬度值(LSM)测量。比较同一肝纤维化程度下3个年龄段儿童LSM的差异,评估年龄对LSM判定肝纤维化程度的影响。采用受试者工作特征曲线(ROC曲线)分析LSM诊断不同年龄段儿童乙型肝炎显著肝纤维化(F≥2)、进展期肝纤维化(F≥3)的界值。符合正态分布的计量资料多组间比较采用单因素方差分析;不符合正态分布的计量资料多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Wilcoxon检验。计数资料多组间比较采用χ2检验。 相关性采用Spearman 等级相关分析。结果 轻度肝纤维化患儿186例,学龄前、学龄、青少年3组轻度肝纤维化患儿LSM分别为4.9(4.3~5.6)kPa、5.5(4.5~6.3)kPa、 6.0(5.4~7.0)kPa,其中学龄前组与青少年组比较差异有统计学意义(Z=10.929,P=0.003);中度肝纤维化患儿60例,3组中度肝纤维化患儿LSM分别为5.6(4.5~6.5)kPa、6.4(5.4~7.7)kPa、7.1(6.3~8.0)kPa,其中学龄前组与青少年组比较差异有统计学意义(Z=8.517,P=0.011);重度肝纤维化34例,3组重度肝纤维化患儿LSM分别为8.3(7.1~9.2)kPa、9.1(8.5~13.1)kPa、11.1(8.5~12.0)kPa,3组比较差异无统计学意义(χ2=4.553,P=0.103)。≤12岁患儿LSM与肝纤维化程度显著相关(r=0.447,P<0.001)。诊断显著肝纤维化、进展期肝纤维化的界值分别为5.8 kP、7.0 kPa,ROC曲线下面积(AUC)分别为0.74(0.68~0.80)、0.94(0.90~0.97);>12岁患儿LSM与肝纤维化程度显著相关(r=0.722,P<0.001),诊断显著肝纤维化、进展期肝纤维化的界值分别为6.6 kP、8.0 kPa,AUC分别为0.82(0.69~0.92)、0.95(0.85~0.99)。结论 CHB患儿FibroScan检测值LSM与肝纤维化呈显著正相关,可以作为进展期肝纤维化的无创诊断指标。LSM随年龄增长而升高,>12岁患儿的诊断阈值高于≤12岁患儿。
【Abstract】:Objective To investigate the value of transient elastography (FibroScan) in the diagnosis of liver fibrosis in chronic hepatitis B (CHB) children of different ages. Methods A total of 280 CHB children, aged <18 years, who were hospitalized in The Fifth Medical Center of Chinese PLA General Hospital from June 2015 to December 2019 and planned to receive antiviral therapy were enrolled, among whom there were 157 preschool children (aged ≤6 years), 74 school-aged children (aged 6-12 years), and 49 adolescents (aged 12~18 years). Liver biopsy was performed for all children to evaluate the degree of liver fibrosis, and according to the Matevia score, the children were divided into mild group (0≤F<2), moderate group (2≤F<3), and severe group (F≥3); FibroScan was used to determine liver stiffness measurement (LSM). LSM was compared between the children with the same degree of liver fibrosis and different ages to analyze the influence of age on LSM in judging the degree of liver fibrosis. The receiver operating characteristic (ROC) curve was used to analyze the cut-off values of LSM in the diagnosis of significant liver fibrosis (F≥2) and advanced liver fibrosis (F≥3) in children of different ages. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups; the Wilcoxon test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between multiple groups. The Spearman rank correlation analysis was used to evaluate correlation. Results Mild liver fibrosis was found in 186 children, and LSM was 4.9 (4.3-5.6) kPa in the preschool group, 5.5 (4.5-6.3) kPa in the school-aged group, and 6.0 (5.4-7.0) kPa in the adolescent group, with a significant difference between the preschool group and the adolescent group (Z=10.929, P=0.003). Moderate liver fibrosis was observed in 60 children, and LSM was 5.6 (4.5-6.5) kPa in the preschool group, 6.4 (5.4-7.7) kPa in the school-aged group, and 7.1 (6.3-8.0) kPa in the adolescent group, with a significant difference between the preschool group and the adolescent group (Z=8.517, P=0.011). Severe liver fibrosis was found in 34 children, and LSM was 8.3 (7.1-9.2) kPa in the preschool group, 9.1 (8.5-13.1) kPa in the school-aged group, and 11.1 (8.5-12.0) kPa in the adolescent group, with no significant difference between the three groups (χ2=4.553, P=0.103). LSM was significantly correlated with the degree of liver fibrosis in the children aged ≤12 years (r=0.447, P<0.001). LSM had a cut-off value of 5.8 kPa and an area under the ROC curve (AUC) of 0.74 (0.68-0.80) in the diagnosis of significant liver fibrosis and a cut-off value of 7.0 kPa and an AUC of 0.94 (0.90-0.97) in the diagnosis of advanced liver fibrosis. LSM was significantly correlated with the degree of liver fibrosis in the children aged >12 years (r=0.722, P<0.001), with a cut-off value of 6.6 kPa and an AUC of 0.82 (0.69-0.92) in the diagnosis of significant liver fibrosis and a cut-off value of 8.0 kPa and an AUC of 0.95 (0.85-0.99) in the diagnosis of advanced liver fibrosis. Conclusion LSM is positively correlated with the degree of liver fibrosis in CHB children, and therefore, it can be used as a noninvasive indicator for the diagnosis of advanced liver fibrosis. LSM increases with age, and the children aged >12 years have a higher diagnostic threshold than those aged ≤12 years.
【关键字】:乙型肝炎,慢性; 弹性成像技术; 诊断; 年龄分布; 儿童
【Key words】:hepatitis B, chronic; elasticity imaging techniques; diagnosis; age distribution; child
【引证本文】:XU ZQ, DONG Y, WANG FC, et al. Value of transient elastography in the diagnosis of liver fibrosis in chronic hepatitis B children of different ages[J]. J Clin Hepatol, 2020, 36(6): 1268-1272. (in Chinese)
徐志强, 董漪, 王福川, 等. 瞬时弹性成像对不同年龄慢性乙型肝炎肝纤维化患儿的诊断价值[J]. 临床肝胆病杂志, 2020, 36(6): 1268-1272.

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