无创方法诊断慢性病毒性肝炎患儿肝纤维化的准确性

StephenW

无创方法诊断慢性病毒性肝炎患儿肝纤维化的准确性
A ElShahawy 1，M S El-Raziky 2，S A Sharaf 3，A Elsharkawy 4，A Enayet 5 6，H Taher 2
隶属关系
隶属关系

     1个
     埃及开罗国家肝脏病学和热带医学研究所儿科。
     2个
     埃及吉萨市开罗大学医学院儿科和儿科肝病学。
     3个
     埃及吉萨市开罗大学医学院化学病理学。
     4个
     埃及吉萨市开罗大学医学院地方病学和肝病学。
     5个
     埃及吉萨市开罗大学医学院儿科和儿科肝病学。 [email protected]。
     6个
     埃及吉萨市开罗大学医学院 Kasr Alainy 医学院儿科。 [email protected]。

     PMID：36494622 DOI：10.1186/s12876-022-02570-w

抽象的

背景：肝活检是评估肝纤维化程度的参考标准。 此外，这是一种侵入性手术。 瞬时弹性成像 (TE) 是一种准确、无创的方法，用于评估肝脏硬度，作为肝纤维化的替代指标。 天冬氨酸氨基转移酶与血小板比率指数 (APRI) 和透明质酸 (HA) 是肝活检检测肝纤维化的非侵入性替代方法。 本研究旨在确定 APRI、HA 和 TE 在慢性病毒性肝炎患儿肝活检方面的准确性。

方法：这项横断面研究包括 50 名 5-18 岁慢性病毒性乙型肝炎 (HBV) 或丙型肝炎 (HCV) 儿童，他们在实验室测试的九个月内接受了肝活检，确定 APRI 并进行 TE。 将 20 名健康年龄的儿童和性别匹配的患者作为血清 HA 水平的对照组。

结果：研究病例的组织病理学结果显示7例（F0）纤维化，36例轻度（F1,2），2例中度（F3,4）儿童和5例重度（F5,6）儿童。 脂肪变性的中位数 (IQR) 为 4（三例患有 HCV）。 当将所有病例中的 TE、APRI 和 HA 值与其实验室数据相关联时，ALT 和 APRI 值之间存在正相关（P 值 = 0.000），AST 和 HA 值之间存在正相关（P 值 = 0.02） ，以及刚度和 APRI 之间的负相关。 与组织病理学检测的纤维化相比，HA、APRI 和 TE 的敏感性分别为 60.5、65.1 和 60.5%，它们的特异性分别为 71.4、57.1 和 85.7%。 TE 在患有（中度至重度）纤维化的组中显着更高。

结论：APRI、HA 和 TE 是纤维化存在的良好指标，几乎具有相同的准确性。 TE 是区分轻度病例和严重纤维化病例的唯一方法。

关键词：APRI； 慢性肝炎； 透明质酸； 肝活检； 瞬态弹性成像。

© 2022。作者。

StephenW

Accuracy of noninvasive methods for the diagnosis of liver fibrosis in children with chronic viral hepatitis
A ElShahawy  1 , M S El-Raziky  2 , S A Sharaf  3 , A Elsharkawy  4 , A Enayet  5   6 , H Taher  2
Affiliations
Affiliations

    1
    Pediatrics in National Hepatology and Tropical Medicine Institiute, Cairo, Egypt.
    2
    Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Giza City, Egypt.
    3
    Chemical Pathology, Faculty of Medicine, Cairo University, Giza City, Egypt.
    4
    Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Giza City, Egypt.
    5
    Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Giza City, Egypt. [email protected].
    6
    Department of Pediatrics, Kasr Alainy Medical School, Faculty of Medicine, Cairo University, Giza City, Egypt. [email protected].

    PMID: 36494622 DOI: 10.1186/s12876-022-02570-w

Abstract

Background: Liver biopsy is the reference standard for assessing liver fibrosis. Moreover, it is an invasive procedure. Transient elastography (TE) is an accurate, noninvasive method for evaluating liver stiffness as a surrogate of liver fibrosis. The aspartate aminotransferase to platelet ratio index (APRI) and Hyaluronic acid (HA) are noninvasive alternatives to liver biopsy for detecting hepatic fibrosis. This study aimed to identify the accuracy of APRI, HA, and TE concerning liver biopsy in children with chronic viral hepatitis.

Methods: This cross-sectional study included 50 children, 5-18 years with chronic viral hepatitis B (HBV) or hepatitis C (HCV) who underwent liver biopsy within nine months of laboratory tests, determining APRI & performing TE. Twenty healthy children of age and sex-matching patients were included as a control group for the serum HA levels.

Results: The histopathological findings of the studied cases showed seven cases with (F0) fibrosis, 36 cases with mild (F1,2), two children with moderate (F3,4), and five children with severe (F5,6). The median (IQR) of steatosis was 4 (three had HCV). When correlating TE, APRI, and HA values in all cases with their laboratory data, there was a positive correlation between ALT and APRI values (P-value = 0.000), a positive correlation between AST and HA values (P-value = 0.02), and a negative correlation between stiffness and APRI. The sensitivity of HA, APRI, and TE compared to fibrosis detected by histopathology was 60.5, 65.1, and 60.5%, and their specificity was 71.4, 57.1, and 85.7%, respectively. TE was significantly higher in a group with (moderate to severe) fibrosis.

Conclusion: APRI, HA, and TE are good indicators of the presence of fibrosis almost with the same accuracy. TE is the only method to differentiate mild cases from those with significant fibrosis.

Keywords: APRI; Chronic hepatitis; Hyaluronic acid; Liver biopsy; Transient elastography.

© 2022. The Author(s).

StephenW

https://bmcgastroenterol.biomedc ... /s12876-022-02570-w