Liu Kunhui,Gong Yiming,Cai Wei.Efficacy verification of Nomogram tool for an early diagnosis of biliary atresia[J].Journal of Clinical Pediatric Surgery,2023,22(03):211-217.[doi:10.3760/cma.j.cn101785-202207050-003]
Nomogram模型用于胆道闭锁早期诊断的效能验证
- Title:
- Efficacy verification of Nomogram tool for an early diagnosis of biliary atresia
- Keywords:
- Biliary Atresia; Nomograms; Gamma-Glutamyltransferase; Alkaline Phosphatase; Early Diagnosis
- 摘要:
- 目的 对当前热门的胆道闭锁(biliary atresia,BA) Nomogram预测模型进行单中心数据验证,并评估其诊断效能。方法 回顾性分析上海交通大学医学院附属新华医院2009-2020年因婴儿梗阻性黄疸行手术探查的631例患儿临床资料,根据术中胆道探查及造影结果分为胆道闭锁组(500例)和非胆道闭锁组(131例)。在Nomogram模型中输入同一患儿的性别、体重、碱性磷酸酶(alkaline phosphatase,ALP)、γ-谷氨酰转肽酶(gamma-glutamyltransferase,GGT)和直接胆红素(direct bilirubin,DB)数值,得到该患儿预测为BA的风险概率。分别按手术年份和手术时日龄对患儿进行分组。将患儿BA预测概率值与其他肝功能数值在同一坐标系内绘制受试者操作特征(receiver operating characteristic,ROC)曲线,得到诊断BA的曲线下面积(area under the curve,AUC)、灵敏度、特异度,评估该Nomogram预测模型对BA患儿早期诊断的准确性。结果 按手术年份分组,性别、术前体重、手术时日龄和GGT在每个年份亚组内BA患儿和非BA患儿中的差异均有统计学意义(P＜0.05),ALP和DB的差异均无统计学意义(P＞0.05)。在前期组(2009-2014年)和后期组(2015-2020年)的对比中,前期组Nomogram模型和GGT单独诊断的AUC值、灵敏度均明显优于后期组;前期组Nomogram模型的AUC=0.865、灵敏度为84.1%,GGT的AUC=0.851、灵敏度为85.8%;后期组Nomogram模型的AUC=0.787、灵敏度为68.2%,GGT的AUC=0.813、灵敏度为65.2%。按手术时日龄分层,日龄≤50 d和81~90 d的患儿中,Nomogram模型的AUC分别为0.806和0.866,均低于GGT的0.807和0.896;而日龄51~60 d、61~70 d、71~80 d和＞90 d的患儿中Nomogram模型的AUC值均高于GGT。结论 Nomogram预测模型诊断BA较单一指标诊断有较高的AUC值和灵敏度,但在手术时日龄≤50 d或＞80 d的患儿中诊断BA的AUC值较GGT单独诊断要低,因此采用该模型对所有日龄的患儿进行BA预测可能不够准确。
- Abstract:
- Objective To evaluate the efficacy of currently popular Nomogram prediction model for biliary atresia (BA) through a single-center data model.Methods Retrospective review was preformed for 631 children undergoing surgical explorations for infantile obstructive jaundice from 2009 to 2020.According to the findings of intraoperative cholangiography,they were assigned into two groups of BA (n=500) and non-BA (n=131).Gender,body weight,ALP (alkaline phosphatase),GGT (gamma glutamyltransferase) and DB (direct bilirubin) were input into the model for estimating the predicted risk probability of BA in the same child.They were grouped according to operative year and day age at surgery.The predicted probability of BA and other liver function parameters were plotted as receiver operating characteristic curve (ROC) curve in the same coordinate system.And area under the curve (AUC),sensitivity and specificity for diagnosing BA were obtained.Also the accuracy of model for an early diagnosis of BA was evaluated.Results Nomogram predictive model had higher AUC value and sensitivity for diagnosing BA than single parameter diagnosis.However,AUC value for diagnosing BA in children aged≤50 day or > 80 day was lower than that for GGT alone.Thus the prediction of pediatric BA using this model might not be accurate enough.Conclusion Nomogram predictive model has higher AUC value and sensitivity for diagnosing BA than single parameter diagnosis.However,AUC value for diagnosing BA in children aged≤50 day or ＞80 day is lower than that for GGT alone.
参考文献/References:
[1] 沈桢,董瑞,汪吉梅,等.上海地区胆道闭锁筛查报告[J].中华小儿外科杂志,2020,41(11):989-993.DOI:10.3760/cma.j.cn421158-20190507-00336. Shen Z,Dong R,Wang JM,et al.Preliminary report for screening biliary atresia in Shanghai Area[J].Chin J Pediatr Surg,2020,41(11):989-993.DOI:10.3760/cma.j.cn421158-20190507-00336.
[2] Lien TH,Chang MH,Wu JF,et al.Effects of the infant stool color card screening program on 5-year outcome of biliary atresia in Taiwan[J].Hepatology,2011,53(1):202-208.DOI:10.1002/hep.24023.
[3] 吕成超,肖静,向义,等.小儿胆道闭锁手术日龄的危险因素分析及策略[J].肝胆外科杂志,2020,28(3):190-193.DOI:10.3969/j.issn.1006-4761.2020.03.008. Lyu CC,Xiao J,Xiang Y,et al.Analysis and strategy of risk factors for operative day age of biliary atresia[J].J Hepatobiliary Surg,2020,28(3):190-193.DOI:10.3969/j.issn.1006-4761.2020.03.008.
[4] Dong R,Jiang JY,Zhang SH,et al.Development and validation of novel diagnostic models for biliary atresia in a large cohort of Chinese patients[J].E Bio Medicine,2018,34:223-230.DOI:10.1016/j.ebiom.2018.07.025.
[5] Chen XL,Dong R,Shen Z,et al.Value of gamma-glutamyl tran-speptidase for diagnosis of biliary atresia by correlation with age[J].J Pediatr Gastroenterol Nutr,2016,63(3):370-373.DOI:10.1097/MPG.0000000000001168.
[6] Rendón-Macías ME,Villasís-Keever MA,Casta?eda-Muci?o G,et al.Improvement in accuracy of gamma-glutamyl transferase for differential diagnosis of biliary atresia by correlation with age[J].Turk J Pediatr,2008,50(3):253-259.
[7] 姜璟,具钊汝,孙颖华,等.剪切波弹性成像诊断胆道闭锁价值的Meta分析[J].临床小儿外科杂志,2021,20(2):126-132.DOI:10.12260/lcxewkzz.2021.02.005. Jiang JY,Ju ZR,Sun YH,et al.Application of shear wave elastography for diagnosing biliary atresia:a Meta-analysis[J].J Clin Ped Sur,2021,20(2):126-132.DOI:10.12260/lcxewkzz.2021.02.005.
[8] Zhou KJ,Wang J,Xie GX,et al.Distinct plasma bile acid profiles of biliary atresia and neonatal hepatitis syndrome[J].J Proteome Res,2015,14(11):4844-4850.DOI:10.1021/acs.jproteome.5b00676.
[9] Zhou KJ,Xie GX,Wang J,et al.Metabonomics reveals metabolite changes in biliary atresia infants[J].J Proteome Res,2015,14(6):2569-2574.DOI:10.1021/acs.jproteome.5b00125.
[10] Dai SY,Sun YQ,Wu Y,et al.Development and assessment of screening nomogram for biliary atresia based on hepatobiliary ultrasonographic features[J].Front Pediatr,2021,9:625451.DOI:10.3389/fped.2021.625451.
[11] Huang CC,Chuang JH,Chou MH,et al.Matrilysin (MMP-7) is a major matrix metalloproteinase upregulated in biliary atresia-associated liver fibrosis[J].Mod Pathol,2005,18(7):941-950.DOI:10.1038/modpathol.3800374.
[12] Kerola A,Lampela H,Lohi J,et al.Increased MMP-7 expression in biliary epithelium and serum underpins native liver fibrosis after successful portoenterostomy in biliary atresia[J].J Pathol Clin Res,2016,2(3):187-198.DOI:10.1002/cjp2.50.
[13] 罗腾飞,胡文胜.超高效液相色谱-串联质谱法同时测定15种胆汁酸的方法分析[J].检验医学与临床,2018,15(16):2412-2415.DOI:10.3969/j.issn.1672-9455.2018.16.016. Luo TF,Hu WS.Analysis of simultaneous detection of 15 bile acids in human sera by ultra-performance liquid chromatography-tandem mass spectrometry[J].Lab Med Clin,2018,15(16):2412-2415.DOI:10.3969/j.issn.1672-9455.2018.16.016.
[14] Xiao YT,Liu RP,Li XJO,et al.Long noncoding RNA H19 contributes to cholangiocyte proliferation and cholestatic liver fibrosis in biliary atresia[J].Hepatology,2019,70(5):1658-1673.DOI:10.1002/hep.30698.
[15] Gu YH,Yokoyama K,Mizuta K,et al.Stool color card screening for early detection of biliary atresia and long-term native liver survival:a 19-year cohort study in Japan[J].J Pediatr,2015,166(4):897-902.e1.DOI:10.1016/j.jpeds.2014.12.063.
[16] Chen Y,Zhao DY,Gu SL,et al.Three-color risk stratification for improving the diagnostic accuracy for biliary atresia[J].Eur Radiol,2020,30(7):3852-3861.DOI:10.1007/s00330-020-06751-7
相似文献/References:
[1]毛永忠,汤绍涛,阮庆兰,等.胆道闭锁肝组织MMP-1、MMP-2、TIMP-1的表达与预后研究[J].临床小儿外科杂志,2007,6(01):5.
[2]毛永忠,汤绍涛,阮庆兰,等.胆道闭锁肝脏组织MMP-2、TGF-β_1的表达及意义[J].临床小儿外科杂志,2007,6(03):5.
[3]余梦楠 刘钢 黄柳明 王伟. 胆道闭锁术后反复发作性胆管炎的细菌谱分析及抗生素选择[J].临床小儿外科杂志,2012,11(03):187.
[J].Journal of Clinical Pediatric Surgery,2012,11(03):187.
[4]董淳强 杨体泉 董昆. 胆道闭锁术后早期胆管炎风险因素分析[J].临床小儿外科杂志,2013,12(05):348.
[5]陈功 郑珊 孙松. 不同年龄胆道闭锁患儿手术效果分析[J].临床小儿外科杂志,2014,13(01):22.
[6]谭梅军 陶强 黄金狮. IL-17在胆道闭锁患儿肝组织中的表达及意义[J].临床小儿外科杂志,2014,13(04):302.
[7]杨文萍 吴艳 张守华. 胆道闭锁患者肝脏组织病理改变的综合评价[J].临床小儿外科杂志,2015,14(01):10.
[8]李康 阳历 汤绍涛. 胆道闭锁患者肝内胆管γδT 细胞和调节性T细胞浸润及意义[J].临床小儿外科杂志,2015,14(01):16.
[9]刘丹丹 詹江华 高伟. 胆道闭锁患者肝门的病理解剖学研究[J].临床小儿外科杂志,2015,14(01):20.
[10]张震 李龙 乔国梁. 胆道闭锁Kasai术后生存率及条件生存率分析[J].临床小儿外科杂志,2015,14(01):25.
备注/Memo
收稿日期:2022-7-26。
基金项目:上海市卫健委上海市临床重点专科建设项目-出生缺陷(shslczdzk05702)
通讯作者:蔡威,Email:caiw1978@163.com