Wu Xiaoxia,Liu Wenyue,Sun Xue,et al.Risk factors and prognosis of recurrent cholangitis after Kasai in biliary atresia patients[J].Journal of Clinical Pediatric Surgery,2023,22(03):244-248.[doi:10.3760/cma.j.cn101785-202212005-008]
胆道闭锁患儿Kasai手术后频发胆管炎的危险因素及预后分析
- Title:
- Risk factors and prognosis of recurrent cholangitis after Kasai in biliary atresia patients
- Keywords:
- Biliary Atresia; Cholangitis; Prognosis; Root Cause Analysis
- 摘要:
- 目的 探讨胆道闭锁(biliary atresia,BA)患儿Kasai手术后频发胆管炎的危险因素及预后。方法 回顾性分析山西省儿童医院2018年1月至2021年9月因BA行Kasai手术后合并胆管炎患儿的临床资料和随访资料,根据患儿6个月内胆管炎发作次数是否≥3次分为频发胆管炎组和偶发胆管炎组,比较两组性别分布、术前身体质量指数(body mass index,BMI)、术前巨细胞病毒(cytomegalovirus,CMV)感染、行Kasai手术年龄、肝纤维化分级、术前及术后2周肝功能指标和早期胆管炎发生情况,采用Cox回归分析筛选频发胆管炎的危险因素,并比较两组患儿术后黄疸清除(jaundice clearance,JC)率及自体肝生存率。结果 本研究共纳入60例因BA行Kasai手术后发生胆管炎患儿,其中频发胆管炎组20例,偶发胆管炎组40例,两组患儿性别、术前BMI指数、术前CMV感染、Kasai手术年龄和肝纤维化分级比较差异均无统计学意义(P＞0.05)。频发胆管炎组术前总胆汁酸水平显著低于偶发胆管炎组(Z=-2.070,P＜0.05)。两组患儿术前丙氨酸转氨酶(alanine transaminase,ALT)[(169.47±93.53)比(173.96±96.25) U/L]、天冬氨酸转氨酶(aspartate trans-aminase,AST)[242.50(169.68,296.13)比244.50(148.50,297.00) U/L]、γ-谷氨酰转肽酶(gamma-glutamyl transferase,GGT)[572.00(310.75,895.75)比388.00(245.50,695.25) U/L]、总胆红素(total bilirubin,TBIL)[(219.61±73.08)比(207.38±58.63)μmol/L]、直接胆红素(direct bilirubin,DBIL)[122.70(104.50,163.25)比116.70(81.42,158.35)μmol/L]和白蛋白(albumin,Alb)[(36.27±2.91)比(37.88±4.90) g/L]水平差异无统计学意义(P＞0.05)。两组患儿术后2周ALT[(211.23±144.87)比(229.87±104.76) U/L]、AST[162.50(108.17,225.75)比196.50(160.75,235.43) U/L]、GGT[(742.85±438.09)比(584.05±385.31) U/L]、TBIL[136.20(86.05,190.23)比145.50(95.73,213.90)μmol/L]、DBIL[79.85(60.88,122.83)比90.00(61.30,129.30)μmol/L]和Alb[(37.92±5.55)比(39.22±4.55) g/L]水平差异无统计学意义(P＞0.05)。频发胆管炎组早期胆管炎发生率显著高于偶发胆管炎组,差异有统计学意义(χ2=9.909,P＜0.05)。Cox回归分析结果显示,早期胆管炎是BA患儿Kasai手术后频发胆管炎的危险因素(HR=4.947,95%CI:1.754~13.948,P＜0.05)。频发胆管炎组术后3个月、6个月JC率低于偶发胆管炎组,但差异无统计学意义(P＞0.05),频发胆管炎组术后12个月JC率显著低于偶发胆管炎组,差异有统计学意义(χ2=5.179,P＜0.05)。两组术后1年自肝生存率差异无统计学意义(P＞0.05)。结论 早期胆管炎是BA Kasai手术后频发胆管炎的独立危险因素,频发胆管炎会影响手术后黄疸清除。
- Abstract:
- Objective To explore the risk factors and outcomes of recurrent cholangitis after Kasai in biliary atresia (BA) patients.Methods Retrospective review was conducted for clinical and follow-up data of 60 BA children with cholangitis after Kasai procedure from January 2018 to September 2021.According to whether the frequency of cholangitis episodes was more than or equal to 3 times in half a year,they were divided into two groups of recurrent cholangitis (n=20) and occasional cholangitis (n=40).Gender,preoperative body mass index (BMI),cytomegalovirus (CMV) infection,age at Kasai surgery,liver fibrosis grade,serum levels of liver function parameters at preoperation and Day 14 postoperation and the occurrence of early cholangitis were compared between two groups.Cox regression analysis was performed for estimating the risk factors of recurrent cholangitis.Postoperative jaundice clearance (JC) rate and postoperative native liver survival rate were also compared between two groups.Results No significant differences existed in gender,preoperative BMI,CMV infection,age at Kasai or liver fibrosis grade (P>0.05).Serum total bile acid level at preoperation was significantly lower in recurrent cholangitis group than that in occasional cholangitis group (Z=-2.070,P<0.05).Alanine transaminase(ALT)[(169.47±93.53)U/L],Aspartate trans aminase(AST)[(173.96±96.25)U/L],[242.50(169.68,296.13)ratio 244.50(148.50,297.00)U/L],gamma-glutamyl transferase(GGT)[572.00(310.75,895.75)than 388.00(245.50,695.25)U/L],total bilirubin,(219.61±73.08)ratio(207.38±58.63)μmol/L),direct bilirubin(DBIL)ratio(122.70(104.50,163.25)ratio 116.70(81.42,158.35)μmol/L］and albumin,Alb[(36.27±2.91)vs.(37.88±4.90)g/L]at preoperation between 2 groups had no significant difference(P>0.05).ALT[(211.23±144.87)to(229.87±104.76)U/L]and AST[162.50(108.17,225.75)to 196.50(160.75,235.43)U/L],GGT[(742.85±438.09)vs.(584.05±385.31)U/L],TBIL[136.20(86.05,190.23)vs.145.50(95.73,213.90)μmol/L],DBIL[79.85(60.88,122.83)vs.90.00(61.30,129.30)μmol/L]and Alb[(37.92±5.55)vs.(39.22±4.55)g/L]at day 14 postoperation between 2 groups were not significantly different(P>0.05).The incidence of early cholangitis was significantly higher in recurrent cholangitis group than that in occasional cholangitis group (χ2=9.909,P<0.05).Cox regression analysis revealed that early cholangitis was risk factor for recurrent cholangitis; JC rate of recurrent cholangitis group was lower than that of occasional cholangitis group at Month 3/6 postoperation.However,the difference was not statistically significant (P>0.05).JC rate at Month 12 postoperation was significantly lower in recurrent cholangitis group than that in occasional cholangitis group (χ2=5.179,P<0.05).No significant inter-group difference existed in native liver survival rate at 1 year postoperation (P>0.05).Conclusion Early cholangitis is an independent risk factor for recurrent cholangitis after Kasai in BA children.And recurrent cholangitis affects the postoperative jaundice clearance.
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备注/Memo
收稿日期:2022-12-3。
基金项目:山西省卫生健康委课题(2022074),山西省儿童医院院内课题(2021027)
通讯作者:任红霞,Email:renhongxia100@sina.com