肝脏硬度测量值预测胆道闭锁术后五年自体肝生存的价值研究

Predicting five-year native liver survival after Kasai procedure of biliary atresia by liver stiffness measurement

目的探索肝脏硬度测量值(liver stiffness measurement,LSM)预测胆道闭锁术后5年自体肝生存的价值。方法回顾性收集2012年4月至2013年2月于首都医科大学附属北京儿童医院普通外科行Kasai手术治疗的31例胆道闭锁(Biliary Atresia,BA)患儿,其中男童11例,女童20例。收集患儿术前、术后2周、术后4周以及术后8周的LSM和血生化指标,并对术时肝脏病理进行肝纤维化分级。随访终点为发生死亡、肝移植或术后自体肝生存满5年。以术后5年是否自体肝生存分为5年自体肝生存组和5年非自体肝生存组,采用ROC曲线分析方法,获得术后早期LSM预测术后5年自体肝生存的截点值及相应的灵敏度和特异度。结果5年自体肝生存组16例(男童8例,女童8例),5年非自体肝生存组15例(男童3例,女童12例)。两组手术日龄、手术时肝脏病理分级、术前LSM、术后2周LSM差异比较均无统计学意义(P>0.05)。两组术后4周LSM分别为(11.3±4.3)kPa和(19.6±9.7)kPa,术后8周LSM分别为(14.6±7.7)kPa和(38.2±22.3)kPa,差异均有统计学意义(P<0.05)。通过ROC曲线分析发现,术后4周和术后8周用于预测5年自体肝生存的LSM截点值分别为13.2 kPa(ROC曲线下面积=0.871,灵敏度=81.8%,特异度=75.0%)和21.6 kPa(ROC曲线下面积=0.898,灵敏度=81.8%,特异度=91.7%)。结论LSM可预测胆道闭锁Kasai术后5年自体肝生存情况,术后4周LSM>13.2 kPa和术后8周LSM>21.6 kPa均预示5年自体肝生存的可能性降低。

Objective To explore the value of liver stiffness measurement(LSM)in predicting five-year native liver survival after Kasai procedure in children with biliary atresia(BA).Methods From April 2012 to February 2013,31 cases of BA undergoing Kasai operation were analyzed retrospectively.There were 11 boys and 20 girls.The LSM and liver function were collected before operation and at 2/4/8 weeks after operation.Liver fibrosis was graded according to liver pathology during operation.The endpoints of follow-up were death,liver transplantation or five-year native liver survival.They were divided into two groups based upon five-year native liver survival.Results There were 16 cases in native liver survival group(8 boys,8 girls)and 15 cases in non-native liver survival group(3 boys,12 girls).No significant inter-group differences existed in operative age,liver fibrosis grade,LSM before operation or 2 weeks after operation.The difference of LSM at 4 and 8 weeks after operation was statistically significant,(11.3±4.3)vs(19.6±9.7)kPa and(14.6±7.7)vs(38.2±22.3)kPa,respectively.According to ROC curve analysis,the LSM cutoff values for predicting five-year native liver survival were 13.2 kPa(4 weeks after operation)with AUC=0.871,sensitivity=81.8%,specificity=75.0%and 21.6kPa(8 weeks after operation)with AUC=0.898,sensitivity=81.8%,specificity=91.7%,respectively.Conclusion LSM may be employed for predicting five-year native liver survival of BA children after Kasai operation.LSM>13.2 kPa at 4 weeks and 21.6 kPa at 8 weeks after operation indicate that the possibility of five-year native liver survival decreases.