| Objective To evaluate the diagnostic value of hepatic stiffness(LSM),APRI and FIB-4 in hepatic fibrosis due to biliary atresia.Methods 110 cases of biliary atresia with Kasai operation from January 1,2016 to December 31,2018 were studied retrospectively.Liver pathological specimens during operation,blood routine examination and liver function within 1 week before operation,and LSM values measured by tranient elastography were collected.According to METAVIR classification,110 cases of liver fibrosis were divided into five grades(F0-F4),no F0(no hepatic fibrosis),F1(mild hepatic fibrosis),F2(obvious hepatic fibrosis),F3(progressive hepatic fibrosis)and F4(cirrhosis).In this study,the patients were divided into groups:non-obvious hepatic fibrosis group(F < 2 group)and obvious hepatic fibrosis group(F ≥2 group),non-progressive hepatic fibrosis group(F <3 group)and progressive hepatic fibrosis group(F ≥ 3 group),non-cirrhosis group(F < 4 group)and cirrhosis group(F ≥ 4 group).According to the formula,the specific values of APRI and FIB-4 were calculated.The predictive probability of LSM+APRI,LSM+FIB-4,LSM+APRI+FIB-4 was obtained by binary logistic regression.The area under ROC curve was used to judge the value of LSM,APRI,FIB-4,LSM+APRI,LSM+FIB-4,LSM+APRI+FIB-4 in the diagnosis of obvious liver fibrosis,progressive liver fibrosis and cirrhosis respectively.The Yoden index and professional knowledge were used to find out the value.To the corresponding optimal critical value.Results(1)The AUC of LSM for judging obvious hepatic fibrosis(F≥2)in biliary atresia was 0.874,with 9.25 kPa as the critical value.The sensitivity,specificity,positive predictive value and negative predictive value were 71.2%,100%,100% and 16.7% respectively.The AUC of APRI for judging obvious hepatic fibrosis(F ≥ 2)in biliary atresia was0.636,with 0.68 as the critical value.The sensitivity,specificity,positive predictive value and negative predictive value value were 76.9%,66.7%,97.6% and 14.3%,respectively.The AUC of FIB-4 for judging obvious hepatic fibrosis(F ≥ 2)in biliary atresia was 0.622,with 0.047 as the threshold.The sensitivity,specificity,positive predictive value and negative predictive value of FIB-4 were 88.5%,50.0%,96.8% and 20.0%,respectively.The AUC of LSM+APRI for judging obvious hepatic fibrosis(F ≥ 2)in biliary atresia was 0.867,with 0.96 as the threshold.The sensitivity,specificity,positive predictive value and negative predictive value were 71.2%,100%,100% and 16.7%,respectively.The AUC of LSM+FIB-4 for judging obvious hepatic fibrosis(F ≥ 2)in biliary atresia was 0.878,with 0.96 as the threshold.The sensitivity,specificity,positive predictive value and negative predictive value were71.2%,100%,100% and 16.7%,respectively.The AUC ofLSM+APRI+FIB-4 for judging obvious hepatic fibrosis(F≥2)in biliary atresia was 0.869,with 0.96 as the threshold.The sensitivity,specificity,positive predictive value and negative predictive value were 71.2%,100%,100% and 16.7%,respectively.(2)The AUC of LSM for judging progressive hepatic fibrosis(F≥3)in biliary atresia was 0.781,with 10.75 kPa as the threshold.The sensitivity,specificity,positive predictive value and negative predictive value were 68.1%,86.8%,90.7% and 58.9%,respectively.The AUC of APRI for judging progressive hepatic fibrosis(F ≥ 3)in biliary atresia was 0.519,with 0.70 as the threshold.The sensitivity,specificity,positive predictive value and negative predictive value were 79.2%,36.8%,70.4%and 48.3%,respectively.The AUC of FIB-4 for judging progressive hepatic fibrosis(F ≥ 3)in biliary atresia was 0.506,with 0.04 as the threshold.The sensitivity,specificity,positive predictive value and negative predictive value of FIB-4 were 88.9%,23.7%,68.8% and 52.9%,respectively.The AUC of LSM+APRI for judging progressive hepatic fibrosis(F≥3)in biliary atresia was 0.777,with 0.66 as the threshold.The sensitivity,specificity,positive predictive value and negative predictive value were 68.1%,81.6%,87.5% and 57.4%,respectively.The AUC of LSM+FIB-4 for judging progressive hepatic fibrosis(F ≥ 3)in biliary atresia was 0.786,with 0.68 as the threshold.The sensitivity,specificity,positive predictive value and negative predictive value were 68.2%,89.5%,92.0% and 56.7% respectively.The AUC of LSM+APRI+FIB-4 for judging progressive hepatic fibrosis(F ≥ 3)in biliary atresia was0.794,with 0.66 as the threshold.The sensitivity,specificity,positive predictive value and negative predictive value were 68.1%,92.1%,94.2%and 60.3% respectively.(3)The AUC of LSM for judging biliary atresia cirrhosis(F≥4)was0.855,with 11.85 kPa as the threshold.The sensitivity,specificity,positive predictive value and negative predictive value were 87.0%,73.6%,46.5%and 95.5%,respectively.The AUC of APRI for judging biliary atresia cirrhosis(F ≥ 4)was 0.701,with 0.82 as the threshold.The sensitivity,specificity,positive predictive value and negative predictive value were100%,43.7%,31.9% and 100%,respectively.The AUC of FIB-4 for judging biliary atresia cirrhosis(F ≥ 4)was 0.717,with 0.09 as the threshold.The sensitivity,specificity,positive predictive value and negative predictive value were 82.6%,56.3%,33.3% and 92.5%,respectively.The AUC of LSM+APRI for judging biliary atresia cirrhosis(F≥4)was 0.864,with 0.17 as the threshold.The sensitivity,specificity,positive predictive value and negative predictive value were 78.3%,85.1%,58.1% and 93.7%,respectively.The AUC of LSM+FIB-4 for judging biliary atresia cirrhosis(F ≥ 4)was 0.859,with 0.14 as the threshold.The sensitivity,specificity,positive predictive value and negative predictive value were 87.0%,74.7%,47.6% and 95.6%,respectively.The AUC of LSM+APRI+FIB-4 for judging biliary atresia cirrhosis(F ≥ 4)was 0.865,with 0.17 as the threshold.The sensitivity,specificity,positive predictive value and negative predictive value were78.3%,86.2%,60.0% and 93.7%,respectively.Conclusion LSM has high accuracy in the classification of hepatic fibrosis in children with biliary atresia.The critical values of LSM in the diagnosis of obvious hepatic fibrosis(F≥2),progressive hepatic fibrosis(F ≥ 3)and cirrhosis(F ≥ 4)are 9.25 kPa,10.75 kPa and 11.85 kPa,respectively.The clinical value of LSM in the diagnosis of hepatic fibrosis is higher than APRI and FIB-4. |
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