Morphological and ultrasound features of liver fibrosis in children with autoimmune hepatitis

Authors

  • V. S. Berezenko Bogomolets National Medical University, Kyiv, Ukraine,
  • T. D. Zadorozhna SI “Institute of Pediatrics, Obstetrics and Gynaecology named after Academician O.M. Lukianova of NAMS of Ukraine”, Kyiv,
  • Kh. Z. Mykhailiuk Bogomolets National Medical University, Kyiv, Ukraine,
  • B. A. Tarasiuk SI “Institute of Nuclear Medicine and Diagnostic Radiology of NAMS of Ukraine”, Kyiv,
  • V. F. Korobko SI “Institute of Nuclear Medicine and Diagnostic Radiology of NAMS of Ukraine”, Kyiv,
  • S. M. Kelykhevych SI “Institute of Pediatrics, Obstetrics and Gynaecology named after Academician O.M. Lukianova of NAMS of Ukraine”, Kyiv,

DOI:

https://doi.org/10.14739/2310-1237.2018.3.151815

Keywords:

autoimmune hepatitis, children, fibrosis, elastography

Abstract


Aim. To study the ultrasound peculiarities of the liver parenchyma stiffness in children with autoimmune hepatitis by shear wave elastography comparing with the results of liver biopsy morphological investigation.
Materials and methods. 40 children with autoimmune hepatitis were examined during the period of 2015–2018. All children were provided with a complex of laboratory tests according to the protocol, shear wave elastography of the liver and a puncture biopsy of the liver. The disease activity was ranged with the histological index of activity (IHA) according to Knodell
by the results of a morphological study of liver biopsy and biochemical parameters (alanine aminotransferase, total bilirubin,
gamma globulin, immunoglobulin G). The stage of the disease was estimated by the METAVIR histological index (HIS) and
semi-quantitative elastography of the parenchyma shift wave. A comparison of the relationship between the histological activity
of hepatitis and the parameters of the liver stiffness has been made. The changes in 23 children with hypertension were
investigated in dynamics of liver stiffness (after 6 and 12 months of treatment).
Result. A progressive fibrosis was diagnosed in 72.5 % (n = 29) (METAVIR F2) (χ2 = 16.2; P < 0.001 between the group of
children with F1-2 and F3-4 METAVIR). The ROC analysis showed that, the optimal “cut-off point” for the diagnosis of F3 METAVIR fibrosis was the stiffness index of 9.4 kPa, and for F4 METAVIR – 13.0 kPa. Hepatitis activity influenced the stiffness of the liver parenchyma – with a decrease in the activity of the inflammatory process decreased and the rigidity of the liver
parenchyma (P > 0.05). 
Conclusions. In 50 % of children with autoimmune hepatitis, the stage of fibrosis, which was determined by the method of elastography before treatment, corresponded to the data of the morphological study of liver biopsy. The activity of hepatitis affects the liver parenchyma stiffness, with the decrease of inflammatory process activity this index also decreases. The conducted research showed that in the process of treatment (anti-fibrotic and immunosuppressive therapy), after 6 and 12 months, the parameters of liver parenchyma severity decrease significantly (P < 0.05).

References

Guo, L., Zheng, L., Hu, L., Zhou, H., Yu, L., & Liang, W. (2017) Transient Elastography (FibroScan) Performs Better Than Non-Invasive Markers in Assessing Liver Fibrosis and Cirrhosis in Autoimmune Hepatitis Patients. Med Sci Monit, 23, 5106–5112. doi: [10.12659/MSM.907300].

Hartl, J., Denzer, U., Ehlken, H., Zenouzi, R., Peiseler, M., Sebode, M., et al. (2016). Transient elastography in autoimmune hepatitis: Timing determines the impact of inflammation and fibrosis .Journal of Hepatology, 65(4), 769–775. doi: 10.1016/j.jhep.2016.05.023.

Björnsson, E., Talwalkar, J., Treeprasertsuk, S., Neuhauser, M., & Lindor, K. (2011) Patients with typical laboratory features of autoimmune hepatitis rarely need a liver biopsy for diagnosis. Clin Gastroenterol Hepatol, 9(1), 57–63. doi: 10.1016/j.cgh.2010.07.016.

European Association for the Study of the Liver, Asociación Latinoamericana para el Estudio del Hígado (2015) EASL-ALEH Clinical Practice Guidelines: Non-invasive testsfor evaluation of liver disease severity and prognosis. Journal of Hepatology, 63(1), 237–264. doi: 10.1016/j.jhep.2015.04.006.

Bamber, J., Cosgrove, D., Dietrich, C. F., Fromageau, J., Bojunga, J., Calliada, F., et al. (2013) EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med.,34(2), 169–84. doi: 10.1055/s-0033-1335205.

Chung, J. H., Ahn, H. S., Kim, S. G., Lee, Y. N., Kim, Y. S., Jeong, S. W., et al. (2013) The usefulness of transient elastography, acoustic-radiation-force impulse elastography, and real-time elastography for the evaluation of liver fibrosis. Clin Mol Hepatol, 19(2), 156–64. doi: 10.3350/cmh.2013.19.2.156.

Guo, L., Zheng, L., Hu, L., Zhou, H., Yu, L., & Liang, W. (2017) Transient Elastography (FibroScan) Performs Better Than Non-Invasive Markers in Assessing Liver Fibrosis and Cirrhosis in Autoimmune Hepatitis Patients. Med Sci Monit., 23, 5106–5112. doi: 10.12659/MSM.907300.

European Association for the Study of the Liver (2015) EASL Clinical Practice Guidelines: Autoimmune hepatitis. Journal of Hepatology, 63(4), 971–1004. doi: 10.1016/j.jhep.2015.06.030.

Tsochatzis, E. A., Gurusamy, K. S., Ntaoula, S., Cholongitas, E., Davidson, B. R., & Burroughs, A. K. (2011) Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis of diagnostic accuracy. Journal of Hepatology, 54(4), 650–659. doi: 10.1016/j.jhep.2010.07.033.

Castera, L. (2015) Noninvasive Assessment of Liver Fibrosis. Dig Dis, 33, 498–503. doi.org/10.1159/000374097.

Berzigotti, A., & Castera, L. (2013) Update on ultrasound imaging of liver fibrosis. Journal of Hepatology, 59(1), 180–182. doi: 10.1016/j.jhep.2012.12.028.

Thiele, M., Detlefsen, S., Sevelsted Møller, L., Madsen, B. S., Fuglsang Hansen, J., Fialla, A. D., et al. (2016) Transient and 2-Dimensional Shear-Wave Elastography Provide Comparable Assessment of Alcoholic Liver Fibrosis and Cirrhosis. Gastroenterology, 150(1),123–133. doi: 10.1053/j.gastro.2015.09.040.

Cassinotto, C., Boursier, J., de Lédinghen, V., Lebigot, J., Lapuyade, B., Cales, P., et al. (2016) Liver stiffness in nonalcoholic fatty liver disease: A comparison of Supersonic Shear Imaging, FibroScan and ARFI with liver biopsy. Hepatology, 63(6), 1817–27. doi: 10.1002/hep.28394.

Zeng, J., Liu, G. J., Huang, Z. P., Zheng, J., Wu, T., Zheng, R. Q., et al. (2014) Diagnostic accuracy of two-dimensional shear wave elastography for the non-invasive staging of hepatic fibrosis in chronic hepatitis B: a cohort study with internal validation. Eur Radiol., 24(10), 2572–81. doi: 10.1007/s00330-014-3292-9.

Cassinotto, C., Lapuyade, B., Mouries, A., Hiriart, J. B., Vergniol, J., Gaye, D., et al. (2014) Noninvasive assessment of liver fibrosis with impulse elastography: comparison of Supersonic Shear Imaging with ARFI and Fibroscan. J Hepatol., 61(3), 550–7. doi: 10.1016/j.jhep.2014.04.044.

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1.
Berezenko VS, Zadorozhna TD, Mykhailiuk KZ, Tarasiuk BA, Korobko VF, Kelykhevych SM. Morphological and ultrasound features of liver fibrosis in children with autoimmune hepatitis. Pathologia [Internet]. 2018Dec.19 [cited 2024Nov.22];(3). Available from: http://pat.zsmu.edu.ua/article/view/151815

Issue

No. 3 (2018)

Section

Original research

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