Application Of Transient Elastography(FibroTouch)in Paediatric Liver Disease

BackgroundLiver fibrosis is a dynamic process of chronic injury of normal liver cells,which usually occurs in the patients of chronic liver disease,including children,regardless of age and etiologies.The changes in the liver structure are usually slow,but the continuous development of the liver diseases may develop into liver fibrosis or cirrhosis.At present,the gold standard for diagnosis and follow-up of liver fibrosis or cirrhosis in children is the histological examination of percutaneous liver biopsy.However,the pathological examination of liver biopsy has its limitations.In recent years,non-invasive methods for detecting liver fibrosis have developed.Transient elastography(TE)is one of the new technologies,and FibroTouch is a new generation equipment of TE.TE is widely used in adults,but there is no report on the application of FibroTouch in children.PurposeWe investigate the possible influencing factors and the feasibility of FibroTouch in children,especially the feasibility of no sedating less than 3 years;analyse the clinical value of noninvasive diagnosis of liver fibrosis by FibroTouch in patients with liver biopsy;study the liver characteristics(liver stiffness(LSM)and fat attenuation parameter(FAP))of the obese children based on FibroTouch;study the liver characteristics of children with infectious mononucleosis(IM)by EB virus infection based on FibroTouch and the changes of liver stiffness;investigate the liver characteristics of cryptogenic liver disease of children based on FibroTouch.Methods1.The object of study was children with 0-18 year in our hospital from June 2016 to December 2017.It was divided into the healthy control group,the obesity group,the IM group and the cryptogenic liver disease group.2.The all biochemical indexes were collected before or after 7 days by FibroTouch.3.The research subjects of unsuccessful detection by FibroTouch were analyzed,and the reasons for the failure and the influencing factors were analyzed.4.The clinical value of noninvasive diagnosis of liver fibrosis by FibroTouch in patients with liver biopsy was analyzed.5.The liver characteristics of obese children,IM children and children with cryptogenic liver disease based on FibroTouch were analyzed.Results1.The total effective rate of FibroTouch for no sedation children(n=1362 cases)aged 0-18 years was 90.8%.The main failure of age(n=125 cases)was less 2 years old children.Age(<2 years)is the independent influence factor of unsuccessful detection(OR=0.217,P<0.001).2.The median LSM of 0-2 years healthy children(n=229 cases)was 3.0 kPa,3-5 years(n=219 cases)was 3.3 kPa,6-18 years(n=73 csaes)was 3.5 kPa.It was not statistical difference among them.3.The diagnosis of significant fibrosis by FibroTouch,LSM was 6.8 kPa(sensitivity 75%,specificity 68.5%),severe liver fibrosis for the cut-off value of 7.9 kPa(sensitivity 100%,specificity 88.6%),cirrhosis for the cut-off value of 12.4 kPa(sensitivity 100%,specificity 97.5%).4.The FAP value of obese children(n=67cases)(259.4+39dB/m)was significantly higher than the control group(n=521cases)(182.9+19 dB/m,P<0.001),and the value of LSM(6.1+2.2 kPa)was significantly higher than the control group(3.3+1.3kPa,P<0.001).5.The LSM(5.1+1.8kPa)of the children in IM group(n=156 cases)was higher than the control group(n=521cases)(3.3+1.3kPa,P<0.001),and the LSM of the children in IM group decreased to 4.2+1.0(kPa)in the recovery period.6.The LSM(6.5+5.5kPa)of children with cryptogenic liver disease(n=172cases)was higher than the control group(n=521cases)(3.3+1.3kPa,P<0.001).Age,bilirubin and bile acid were independent factors of LSM.Conclusions1.FibroTouch can provide both FAP and LSM,which can be used for noninvasive assessment of hepatic steatosis and liver stiffness and can be widely used in children of different ages.2.The liver stiffness of healthy children in different age groups increased slightly with the increase of age,but there was no statistical difference.3.FibroTouch can be used as a noninvasive tool for the evaluation of liver fibrosis.4.The obese children increased the risk of fatty liver,with a higher FAP,LSM.5.The liver stiffness of IM patients decreased in the recovery period.6.The children with cryptogenic liver disease had the risk of liver fibrosis.