结合超声弹性成像的列线图对葛西手术预后的预测价值

Predictive value of nomogram combined with elastography in the prognosis of Kasai portoenterostomy

目的:利用剪切波弹性成像(SWE)联合临床常用指标建立列线图预测胆道闭锁(BA)患儿葛西手术(KPE)后的自体肝生存率(NLS)。方法:共纳入BA患儿102例,记录基线资料以及术后3个月时的并发症、血清学指标及肝脏弹性测量(LSM)值作为潜在预测指标并开展3年随访。利用随机数字表法分配得到训练队列68例与验证队列34例。在训练队列中利用多因素分析确定影响BA患儿预后的独立因素;并以此建立列线图来估计BA患儿1、2、3年的NLS。列线图在训练队列中进行内部验证,在验证队列中进行外部验证。结果:多因素分析结果显示手术时日龄、METAVIR评分、LSM值、出现胆管炎以及黄疸未消退均与NLS缩短相关(P值均<0.05)。基于上述因子建立了可以预测BA患儿KPE后3年内NLS的列线图,其在训练队列和验证队列中均具有良好的区分度(训练队列:AUC=0.861、0.841、0.836;验证队列:AUC=0.815、0.780、0.786)和校准度(训练队列:1年NLS:χ^(2)=6.438,P=0.598,2年NLS:χ^(2)=8.170,P=0.417,3年NLS:χ^(2)=11.213,P=0.190;验证队列:1年NLS:χ^(2)=5.344,P=0.876,2年NLS:χ^(2)=7.860,P=0.672,3年NLS:χ^(2)=9.881,P=0.231)。结论:临床常用指标联合SWE建立的列线图可以准确预测BA患儿KPE后3年内的NLS,有助于及时采取预防措施从而改善预后。

Objective:To establish a nomogram based on shear wave elastography(SWE)combined with regular indicators to predict the native liver survival(NLS)of patients with biliary atresia(BA)after Kasai portoenterostomy(KPE).Methods:A total of 102 children with BA were enrolled.The baseline data,and complications,serological indicators and liver stiffness measurement(LSM)values at 3 months after surgery were recorded as potential predictors.All BA patients were followed up for 3 years.The random number table method was used to allocate 68 patients in the training cohort and 34 patients in the validation cohort.Multivariate analysis was used in the training cohort to determine the independent factors affecting the prognosis of BA children.Based on this,a nomogram was established to estimate the NLS of BA children at 1,2,and 3 years.The nomogram was verified internally in the training cohort and verified externally in the validation cohort.Results:Multivariate analysis showed that the age at operation,METAVIR score,LSM value,cholangitis and unresolved jaundice were all associated with the shortening of NLS(all P<0.05).Based on the above factors,a nomogram predicting the NLS within 3 years after KPE in BA children was established,with good discrimination(training cohort:AUC=0.861,0.841,0.836;validation cohort:AUC=0.815,0.780,0.786)and calibration(training cohort:1-year NLS:χ^(2)=6.438,P=0.598,2-year NLS:χ^(2)=8.170,P=0.417,3-year NLS:χ^(2)=11.213,P=0.190;validation cohort:1-year NLS:χ^(2)=5.344,P=0.876,2-year NLS:χ^(2)=7.860,P=0.672,3-year NLS:χ^(2)=9.881,P=0.231)in both training and validation cohorts.Conclusion:The nomogram based on regular indicators and SWE can accurately predict the NLS within 3 years after KPE in BA children,which is helpful to take timely preventive measures to improve patients’prognosis.