Modern methods for diagnostics of liver fibrosis in children

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Abstract


This review is dedicated to nowaday methods of liver fibrosis diagnostic in children. The article presents various types of puncture biopsy of the liver. Implementation of the immunohistochemical method in the morphological analysis of biopsy samples allows us to expand our understanding of the pathogenesis of chronic liver diseases, the role of the concomitant infectious agent in the progression of the disease and its outcomes. Instrumental methods for visualizing fibrosis with an assessment of their diagnostic significance are observed in the article. Ultrasound is a screening method among instrumental examination. Computed and magnetic resonance imaging are obligate imaging methods for suspected fibrosis, but they are do not allow to verify its stage. The advantages and disadvantages of various types of elastography are presented. Promising directions of fibrosis diagnostics are associated with scintigraphy, acoustic structural quantitative analysis. Special attention is paid to serum markers for assessing the stage of liver fibrosis in children; data about the role of several fibrosis markers, such as hyaluronic acid, type IV collagen, transforming growth factor β1, as well as APRI, FIB-4, FibroTest indices in children are presented. Further study of the pathogenetic aspects of fibrogenesis, exploration of new non-invasive techniques for differentiation the intermediate stages of liver fibrosis, and the development of its prognostic criteria are required.


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About the authors

Natalya A. Efremova

Pediatric Research and Clinical Center for Infectious Diseases

Author for correspondence.
Email: naftusy@inbox.ru

Russian Federation, Saint Petersburg

Junior Researcher of Viral Hepatitis Department

Larisa G. Goryacheva

Pediatric Research and Clinical Center for Infectious Diseases; St. Petersburg State Pediatric Medical University

Email: goriacheva@list.ru

Russian Federation, Saint Petersburg

MD, PhD, Dr Med Sci, Professor, Leading Researcher of Viral Hepatitis Department, Associate Professor

Irina A. Karabak

Pediatric Research and Clinical Center for Infectious Diseases

Email: karabak@mail.ru

Russian Federation, Saint Petersburg

Postgraduate Student of the Department of Tissular and Pathomorphological Research Methods, Pathologist of Department of Pathology

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Supplementary files

Supplementary Files Action
1.
Fig. 1. An illustration of application of histological, immunohistochemical and morphometric methods in the study of liver fibrosis: а – Liver biopsy specimen with intralobular lymphocyte infiltration, hematoxylin and eosin staining, ×400; b – Serial section of the same biopsy specimen with expression of the CD8-receptor on T-lymphocytes, IHC, DAB (brown staining), ×400; c – Quant Center morphometric program, which calculates CD8-positive lymphocytes (outlined by the red line, on the inset, ×1000) in the selected area of interest (outlined by the green line)

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2.
Fig. 2. Modulation of SMA-alfa positive stellate cells’s morphology in liver tissue depending on histological activity of chronic hepatitis: а – mild activation of SMA-alfa positive stellate cells (arrows), low histological activity of chronic hepatitis; b – pronounced activation of SMA-alfa positive stellate cells (arrows), high histological activity of chronic hepatitis. IHC, DAB (brown staining), ×400

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