담즙정체성 간질환 환자에서 간섬유화스캔의 효용성에 대한 연구

담즙정체성 간질환 환자에서 간섬유화스캔의 효용성에 대한 연구

Some Considerations About Fibroscan in Extrahepatic Cholestatic Liver Disease

(구연):
Release Date : 2017. 10. 26(목)
Sowon Park, Yoonkoo Kang, Seung Kim , Hong Koh
Yonsei Univeresity Severance Children's Hospital Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Pediatric Liver Research Group1
박소원, 강윤구, 김승 , 고홍
연세의대 세브란스 어린이병원 소아소화기영양과1

Abstract

Background/Aim: Although liver FibroScan is one of the non-invasive methods which can be done easily to detect the severity of liver fibrosis, its reliability in extrahepatic cholestatic liver disease has been questioned recently. We analyzed five non-invasive methods in cholestatic liver disease to validate the diagnostic performance of FibroScan. Materials and Methods: Retrospective cohort study was done in 135 patients with biliary atresia, the most common extrahepatic cholestatic liver disease in children, at Severance Children’s Hospital from January 2007 to December 2016. Medical records were reviewed, including clinical and demographic data such as biochemical parameters indicating hepatic injuries, liver histopathology, liver stiffness measurement, Aspartate aminotransferase (AST)–to-platelet ratio index (APRI), AST/Alanine aminotransferase (ALT) ratio (AAR), Fibrosis-4, and gamma-glutamyl transpeptidase (GGT)-to-platelet ratio (GPR). The five non-invasive methods were evaluated to see their correlations with liver fibrosis. Results: The patients were categorized into four groups according to the Metavir score. Mean age and biochemical parameters such as total and direct bilirubin, AST, ALT, Platelet, and Prothrombin time in international normalized ratio showed statistically significantl difference among the four fibrosis scoring groups. Five non-invasive methods were analyzed to validate the diagnostic performances. Liver stiffness measurement appeared to have good diagnostic performance in the extent of liver fibrosis (Area Under Receiver Operating Characteristic of liver stiffness measurement is 0.81 (F 0~1 vs 2~4), 0.74 (F 0~2 vs 3~4) and 0.86 (F 0~3 vs 4) correspondingly). By using Youden’s index, we have calculated cut point values of each method (cut point is 8.40 kilopascal (F ≥ 2), 12.20 kilopascal (F ≥ 3), and 17.90 kilopascal (F=4) respectively). Conclusion: Liver FibroScan can be considered again as a reliable non-invasive method to find the extent of liver cirrhosis in cholestatic liver disease. Higher cut point values should be considered for the proper assessment for the liver fibrosis.

Keywords: cholestasis, fibroscan, biliary atresia