SOVREMENNAYA PEDIATRIYA.2018.6(94):14-21; doi 10.15574/SP.2018.94.14

Berezenko V. S., Dyba M. B., Mykhailiuk H. Z., Tkalyk O. M., Krat V. V., Korobko V. F., Tarasyuk B. A.
SI Institute of Pediatrics, Obstetrics and Gynecology named after academician O. Lukyanova of the National Academy of Medical Sciences of Ukraine, Kyiv
SI Institute of Nuclear Medicine and Radiation Diagnosis of NAMS of Ukraine, Kyiv

Objective: to estimate the hepatic fibrosis stage in children with chronic hepatitis C (CHC) using a combination of two non-invasive techniques — instrumental (shear-wave elastography) and serological; the latter is in detecting the markers of fibrosis (APRI, FIB-4).

Materials and methods. There were 33 children aged 3–18 years with CHC examined. The stage of hepatic fibrosis was diagnosed by the APRI index and elastography; besides, 15 patients underwent liver biopsy. The <F2 fibrosis stage corresponded to such APRI and liver elastography indicators as <0.42 and <6.1 kPa, respectively; >F2 — >0.5 and >6.9 kPa; F4 (cirrhosis) — >1 kPa and 11.5 kPa, respectively.

Results. The APRI index in patients was 0.67±0.27; liver elastography — 6.7±2.2 kPa; the FIB-4 index was 0.31±0.2 (mean± standard deviation). The <F2 fibrosis stage was diagnosed in 15% (n=5) of patients according to APRI, and the corresponding stage of fibrosis was determined in 45% (n=15) of children via elastography; by means of morphological examination of liver biopsy specimens — in 20% (n=3) of patients; >F2 was diagnosed in 54% (n=18), in 18% (n=6) and in 60% (n=9), respectively; F4 — in 15% (n=5), in 6% (n=2) and in 20% (n=3), respectively. Despite the fact that the selected diagnostic criteria of the fibrosis stages by means of non-invasive techniques had a sufficiently high informational value, in practical application these methods have differences in predicting the liver fibrosis stage in children with chronic hepatitis C.

Conclusions. Using a combination of two non-invasive techniques to predict the stage of liver fibrosis can provide a reliable method of non-invasive control of the liver disease progression in children and significantly reduce the number of biopsies performed.

Key words: children, chronic hepatitis C, fibrosis, elastography, APRI, FIB-4.

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Article received: Aug 20, 2018. Accepted for publication: Oct 18, 2018.