目的:研究超声(US)定义的囊性纤维化相关性肝病(CFLD)的患病率,并描述具有CFLD和不具有CFLD(nCFLD)的患者的临床和放射学特征的差异;有和没有门脉高压(PHT和nPHT)。
方法:我们诊所的CF(CwCF)儿童从3岁开始定期筛查肝脏US。肝实质检查结果分为正常,同质,异质和结节。对于我们的研究,我们将PHT定义为脾肿大和/或腹水的美国证据,异常的入口流,静脉曲张,如果存在,韧带圆再通。人口统计,临床,比较两组的营养和肺功能-CFLD/nCFLD;以及亚组-PHT和nPHT。测量作为纤维化标志物的γ谷氨酰转移酶(GGT)/血小板比率(GPR)。
结果:来自227CwCF,40(17%)被排除(3岁以下或肝脏疾病的替代原因)。在剩下的187,107(57%)美国正常,80例(43%)有CFLD;25例(13.4%)有PHT。人口统计学没有显著差异,BMI-z评分,肺功能,CFLDvsnCFLD和PHTvsnPHT存在胃造口术或胰腺功能不全。CF相关糖尿病(CFRD)与CFLD和nCFLD显著相关(P=0.0086)。PHT与nPHT相比,GGT较高,血小板计数较低(P=0.0256和P=0.0001)。注意与GPR升高密切相关(P=0.016)。US和PHT的结节之间有很强的关联(P=0.0006)。
结论:结节性是晚期肝病的明确标志物,作为纤维化的非侵入性标志物,评分较高。晚期肝病和无/轻度肝病之间的营养和FEV1没有差异。
OBJECTIVE: To
study the prevalence of cystic fibrosis related liver disease (CFLD) as defined by ultrasound (US) and describe difference in clinical and radiological features in those with CFLD and those without CFLD (nCFLD); with and without portal hypertension (PHT and nPHT).
METHODS: Children with CF (CwCF) from our clinic who had regular screening liver US from 3 years of age were included. Liver parenchyma findings were classified into normal, homogeneous, heterogeneous and nodular. For our
study, we defined PHT as US evidence of splenomegaly and/or ascites, abnormal portal flow, varices, ligamentum teres recanalization if present. Demographic, clinical, nutritional and lung function between the two groups-CFLD/nCFLD; and subgroups- PHT and nPHT were compared. Gamma glutamyl transferase (GGT)/ platelet ratio (GPR) as a marker of fibrosis was measured.
RESULTS: From 227 CwCF,40 (17 %) were excluded (below the age of 3 years or alternative cause of liver disease). Of the remaining 187, 107 (57 %) had a normal US, 80 (43 %) had CFLD; 25 (13.4 %) had PHT. There was no significant difference in demographics, BMI-z score, lung function, presence of gastrostomy or pancreatic insufficiency in CFLD vs nCFLD and PHT vs nPHT. CF related diabetes mellitus (CFRD) was significantly associated with CFLD vs nCFLD (P = 0.0086). GGT was higher and platelet count was lower in PHT vs nPHT (P = 0.0256 and P = 0.0001). Nodularity was strongly associated with an elevated GPR (P = 0.016). There was a strong association between nodularity on US and PHT (P = 0.0006).
CONCLUSIONS: Nodularity is a clear marker for advanced liver disease with higher scores for a non-invasive marker for fibrosis. There was no difference in nutrition and FEV1 between advanced liver disease and absent/ milder liver disease.