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

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0.87495%可信区间(95%CI):0.778~0.970]、0.636(95%CI:0.362~0.911)、0.622(95%CI:0.363~0.880);LSM、APRI、FIB-4用于判断胆道闭锁进展性肝纤维化(F≥3)的临界值分别为10.75 kPa、0.70、0.05,AUC分别为0.781(95%CI:0.689~0.873)、0.519(95%CI:0.401~0.636)、0.506(95%CI:0.389~0.623);LSM、APRI、FIB-4用于判断胆道闭锁肝硬化(F≥4)的临界值分别为11.85 kPa、0.82、0.09,AUC分别为0.855(95%CI:0.769~0.942)、0.701(95%CI:0.599~0.803)、0.717(95%CI:0.609~0.825)。相关性分析结果显示,LSM值与AST水平呈正相关(r=0.258,P=0.007),与PLT水平呈负相关(r=-0.248,P=0.009)。结论瞬时弹性成像技术对于胆道闭锁患儿肝纤维化分级具有较高的准确性,其诊断肝纤维化程度的临床价值高于APRI、FIB-4。

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

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 intervalCI]: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 kPa,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 of 0.855(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.