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

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 0.05). 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).

Keywords

• autoimmune hepatitis
• children
• fibrosis
• elastography