Kasai手术前特异性超声征象评估胆道闭锁肝纤维化的价值

Evaluation value of specific liver ultrasonic signs to liver fibrosis in children with biliary atresia before Kasai procedure

目的探讨胆道闭锁(biliary atresia,BA)特异性超声征象与肝纤维化评分的相关性,为Kasai手术前多模态超声评估肝纤维化程度提供依据。方法回顾性分析2020年2月至2022年9月在南京医科大学附属儿童医院经手术确诊为BA并行Kasai手术67例患儿的临床资料,其中男26例,女41例。术前1周内均行BA相关的超声检查,检查年龄为(50.57±18.53)d,范围在17~95 d。术后对肝脏病理标本进行Metavir纤维化评分。Pearson分析和Spearman分析法分析超声检查年龄、肝门部三角索带征(triangular cord sign,TC)厚度、胆囊最大截面积(maximum area of the gallbladder,MAG)、肝脏硬度值(liver stiffness measurement,LSM)、肝纤维化评分间的相关性。绘制受试者操作特征(receiver operating characteristic,ROC)曲线评估TC厚度、MAG、LSM诊断BA肝纤维化程度的效能。结果所有患儿都存在一定程度的肝纤维化,4例(6.0%,4/67)1分,38例(56.7%,38/67)2分,18例(26.9%,18/67)3分,7例(10.4%,7/67)4分。超声检查年龄、TC厚度和LSM在不同纤维化评分患儿间有差异,并且和肝纤维化评分呈正相关。LSM和TC厚度诊断肝纤维化程度的ROC曲线下面积分别为0.783和0.731。相关性分析显示,超声检查年龄、LSM、TC厚度三者之间存在正相关性。结论BA术前超声检查年龄、LSM、TC厚度及肝纤维化评分间均存在不同程度的正相关性。术前特异性超声征象可以对BA肝纤维化程度进行评估,为判断病情提供参考。

Objective To explore the correlation between specific ultrasonographic signs of biliary atresia(BA)and grade of liver fibrosis(LF)to provide rationales for evaluating the degree of LF by multimodal ultrasound before Kasai.Methods From February 2020 to September 2022,the relevant clinical data were retrospectively reviewed for 67 surgically confirmed BA children undergoing Kasai Procedure.There were 26 boys and 41 girls.BA-related ultrasonography was performed within 1 week before operation.The age of examination was(50.57±18.53)(17-95)day.The pathological specimens of liver were evaluated with Metavir fibrosis score at post-operation.Pearson's and Spearman's correlation analyses were performed for examining the correlation among age of ultrasonic examination,thickness of hilar triangular cord(TC)sign,maximal cross-sectional area of gallbladder(MAG),liver stiffness measurement(LSM)and LF score.Receiver operating characteristic(ROC)curve was plotted for evaluating the efficacy of TC thickness,MAG and LSM in diagnosing the degree of LF in BA.Results All of them had a certain degree of liver fibrosis.The score was 1(6.0%,4/67),2(56.7%,38/67),3(26.9%,18/67)and 4(10.4%,7/67).Age of ultrasonic examination,TC thickness and LSM varied among children with different LF scores and they were correlated positively with LF scores.The area under the ROC curve for diagnosing liver fibrosis by LSM and TC thickness was 0.783 and 0.731 respectively.Correlation analysis revealed a positive correlation among age of ultrasonic examination,LSM and TC thickness.Conclusions There were different degrees of positive correlations among preoperative age of ultrasonic examination,LSM,TC thickness and LF score.And specific preoperative ultrasonographic signs may be utilized for evaluating the degree of LF in BA and provide references for judging disease status.