天冬氨酸转氨酶和血小板比值对胆道闭锁肝纤维化预测价值的研究

Predictive value of aspartate aminotransferase-to-platelet ratio index on hepatic fibrosis progression in children with biliary atresia

目的探讨天冬氨酸转氨酶与血小板比值（APRI）对胆道闭锁患儿肝纤维化程度的预测价值。方法回顾性分析2007年12月至2011年12月收治的93例行肝门空肠吻合术（Kasai手术）治疗的胆道闭锁患儿的临床资料，提取相关实验室检查及病理检查等资料，按Scheuer方案进行肝纤维化程度分级。结果无或轻微肝纤维化组（S0-1组）33例，明显肝纤维化组（S2-4组）60例，两组间天冬氨酸转氨酶（AST）、丙氨酶转氨酶（ALT）、AST／ALT、APRI差异均有统计学意义（P〈0．05），5个参数ROC曲线下面积分别为0．777、0．631、0．351、0．605和0．783；APRI最佳截断点为0．945，其灵敏度和特异性分别为0．817和0．67。进一步将APRI作为肝纤维化程度的预测指标与病理诊断做相关分析，两者中度相关，APRI升高程度与肝纤维化呈正相关（r=0．483，P〈0．01）。按APRI最佳截断点分为APRI≤0．945组与APRI＞0．945组，与术后6个月内存活情况进行卡方检验，两组生存率分别为72．73％和38．33％，差异有统计学意义（P=0．002）。结论APRI与胆道闭锁患儿肝纤维化程度呈正相关，APRI有望成为一个快速、无创、简便获取的参数，在胆道闭锁患儿术前肝纤维化程度的评估中发挥重要作用。

Objective To investigate the predictive valueof aspartate aminotransferase-to-platelet ratio index （APRI） on hepatic fibrosis progression in children with biliary atresia （BA）. Methods A total of 93 patients with BA who underwent Kasai procedure were recruited in this study. The clinical data including laboratory tests and pathological examines were collected and analyzed retrospectively. Wedge hepatic biopsy was performed during surgical procedure. Live cirrhosis was determined by pathological examination. The severity of cirrhosis was graded using Scheuer classification. Results The total cases were divided into 2 subgroups： none or mild （stage 0-1） group, and severe fibrosis group （stage 2-4）. The AST, ALT, PLT, AST/ALT and APRI were compared, and significant difference was found between 2 groups （all P〈0. 05）. The area under ROC curve of AST, ALT, PLT, AST/ALT and APRI were 0. 777,0. 631, 0. 351, 0. 605 and 0. 783, respectively. The optimal cut-off of APRI was 0. 945. The sensitivity and specificity of APRI for prediction liver fibrosis were 0. 817 and 0. 67, respectively. APRI was found to be moderate correlated with the severity of hepatic fibrosis （r = 0. 483, P〉0. 01）, which was increased with the severity of hepatic fibrosis. The 2-year survival rate of the patients with APRIl0. 945 was significantly higher than that with APRI≤0. 945. Conclusions APRI is positively correlated with the severity of hepatic fibrosis in patients with BA, which can be used to predict hepatic cirrhosis progression.