术前营养状况对胆道闭锁Kasai术后自体肝生存的影响

The influence of preoperative nutritional status on native liver survival after Kasai for biliary atresia

目的:评估胆道闭锁(BA)患儿的营养状况,探讨术前营养不良对Kasai术后自体肝生存的影响。方法:回顾性收集93例行Kasai手术BA患儿临床资料并进行营养状况评估。采用多因素回归分析筛选影响Kasai术后24个月自体肝生存的因素,评估营养不良对24个月自体肝生存的预测价值。结果:93例患儿出现营养不良23例(24.7%),多因素回归模型显示肝纤维化分级(OR=10.803)、术前总胆红素(TB)(OR=1.005)、术后1周γ-谷氨酰转肽酶(γ-GT)(OR=1.002,95%CI:1.000~1.003)、营养不良(OR=4.026,95%CI:2.091~7.751)、肝功能恢复(OR=0.124,95%CI:0.050~0.307)及黄疸清除(OR=0.334,95%CI:0.147~0.757)为24个月自体肝生存的独立影响因素(均P<0.05)。术前营养不良对24个月自体肝生存的特异度最高(94.9%),但敏感性较低(38.9%)。结论:BA患儿术前营养不良可能与Kasai术时日龄大及肝脏纤维化分级高相关,并影响Kasai术后的自体肝生存时间。

Objective:To evaluate the nutritional status of children with biliary atresia(BA)and explore the influence of preoperative malnutrition on native liver survival after Kasai operation.Methods:The clinical data of 93 children with BA undergoing Kasai surgery were retrospectively collected and their nutritional status was evaluated.Multi-factor regression analysis was used to select the factors affecting autogenous liver survival at 24-months after surgery,and the predictive value of malnutrition on autogenous liver survival at 24-months was evaluated.Results:There were 23 cases(24.7%)of the 93 children with malnutrition,and the multi-factor regression model showed that liver fibrosis grade(OR=10.803),preoperative total bilirubin(TB)(OR=1.005),postoperative 1 weekγ-glutamyltranspeptidase(γ-GT)(OR=1.002,95%CI:1.000-1.003),malnutrition(OR=4.026,95%CI:2.091-7.751),liver function recovery(OR=0.124,95%CI:0.050-0.307)and jaundice clearance(OR=0.334,95%CI:0.14-0.757)were independent influencing factors of autogenous liver survival at 24-months(all P<0.05).Preoperative malnutrition had the highest specificity(94.9%)fornative liver survival at 24-months,but the sensitivity was lower(38.9%).Conclusion:Preoperative malnutrition in children with BA may be related to the big age of Kasai surgery and the high grade of liver fibrosis,and affect the survival time of autogenous liver after Kasai surgery.