Yang Yifan,Jiang Jingying,Qian Manning,et al.Value of serum bile acid levels in prognostic evaluation of successful jaundice resolution after Kasai procedure for biliary atresia[J].Journal of Clinical Pediatric Surgery,2024,(08):711-715.[doi:10.3760/cma.j.cn101785-202405062-003]
血清胆汁酸水平对胆道闭锁Kasai术后退黄成功患儿预后评估的价值研究
- Title:
- Value of serum bile acid levels in prognostic evaluation of successful jaundice resolution after Kasai procedure for biliary atresia
- Keywords:
- Biliary Atresia; Surgical Procedures; Operative; Bile Acid; Prognosis
- 摘要:
- 目的 探讨血清胆汁酸水平对胆道闭锁Kasai术后退黄成功患儿预后评估的价值。 方法 回顾性分析2020年1月至2021年12月在复旦大学附属儿科医院接受Kasai术后总胆红素降至正常的115例胆道闭锁患儿临床资料。根据术后6个月血清胆汁酸水平分为≤34 μmol/L组(n=54)和>34 μmol/L组(n=61)。比较两组术后实验室检查指标,包括肝功能、凝血功能、血小板、脾脏大小、肝剪切波弹性成像测定等;前哨事件,包括血小板减少、脾肿大、胃底食管静脉曲张或消化道出血以及肝移植情况。 结果 115例总胆红素降至正常的胆道闭锁患儿术后6个月血清胆汁酸为3~263 μmol/L(中位数34 μmol/L),术后6个月与术后24个月血清胆汁酸水平具有较强相关性(r=0.623,P<0.001)。血清胆汁酸≤34 μmol/L组与血清胆汁酸>34 μmol/L组相比,术后24个月时血清总胆红素[6.5(5.5,10.4)μmol/L比9.1(6.8,12.9)μmol/L]、天冬氨酸氨基转移酶[48(37,72)U/L比88(55,118)U/L]、丙氨酸氨基转移酶[39(24,70)U/L比70(35,98)U/L]、γ-谷氨酰转移酶[73(30,182)U/L比115(45,270)U/L]、胆汁酸水平[21(11,34)μmol/L比80(29,162)μmol/L]、脾肋下长度[0(0,10)mm比16(0,40)mm]、肝剪切波弹性成像值[1.4(1.2,1.6)m/s比1.6(1.3,1.9)m/s]均明显降低,而血清白蛋白[43(41,44)g/L比43(38,44)g/L]、血小板[214(149,318)×109/L比191(96,267)×109/L]水平均升高,差异均具有统计学意义(P<0.05);两组国际标准化比值[0.95(0.93,1.03)比0.97(0.91,1.08)]、25-羟维生素D[34(27,39)ng/mL比34(26,37)ng/mL]水平比较无统计学意义(P>0.05)。胆汁酸≤34 μmol/L组术后24个月内血小板减少发生率[26.9%(14/52)比50.9%(28/55)]、脾肿大发生率[23.8%(10/42)比61.5%(24/39)]、前哨事件总发生率[30.8%(16/52)比70.9%(39/55)]较胆汁酸＞34 μmol/L组明显降低,差异有统计学意义(P<0.05);其术后2年肝移植率为3.7%(2/54),而胆汁酸>34 μmol/L组为26.2%(16/61),差异有统计学意义(P＜0.05)。 结论 胆道闭锁Kasai术后退黄成功患儿术后6个月高血清胆汁酸水平提示存在预后较差的可能。
- Abstract:
- Objective To explore the value of serum bile acid levels in the prognostic evaluation of children with successful jaundice resolution after the Kasai procedure for biliary atresia (BA).Methods A retrospective analysis was conducted on clinical data of 115 children with BA who underwent the Kasai procedure and achieved normal total bilirubin levels between January 2020 and December 2021 at Children’s Hospital of Fudan University.Based on serum bile acid levels at 6 months post-surgery,patients were divided into ≤34 μmol/L and >34 μmol/L groups.Postoperative laboratory indices,including liver function,coagulation function,platelet count,spleen size,and liver shear wave elastography were compared between the two groups.The incidence of sentinel events,including thrombocytopenia,splenomegaly,gastroesophageal varices or gastrointestinal bleeding,and liver transplantation,was also analyzed.Results Among the 115 patients with normal total bilirubin,serum bile acid levels at 6 months post-surgery ranged from 3 to 263 μmol/L (median 34 μmol/L).There was a strong correlation between bile acid levels at 6 months and 24 months post-surgery (r=0.623,P<0.001).Compared to the >34 μmol/L group,the ≤34 μmol/L group had significantly lower levels of total bilirubin[6.5(5.5,10.4)μmol/L vs.9.1(6.8,12.9)μmol/L],aspartate aminotransferase [48(37,72)U/L vs.88(55,118)U/L],alanine aminotransferase [39(24,70)U/L vs.70(35,98)U/L],gamma-glutamyl transferase [73(30,182)U/L vs.115(45,270)U/L],bile acid levels [21(11,34)μmol/L vs.80(29,162)μmol/L],spleen length [0(0,10)mm vs.16(0,40)mm],and liver shear wave elastography values [1.4(1.2,1.6)m/s vs.1.6(1.3,1.9)m/s],while serum albumin [43(41,44)g/L vs.43(38,44)g/L]and platelet counts [214(149,318)×109/L vs.191(96,267)×109/L]were higher,with statistical significance (P<0.05).International normalized ratio [0.95(0.93,1.03) vs.0.97(0.91,1.08)]and 25-hydroxyvitamin D [34(27,39)ng/mL vs.34(26,37)ng/mL]levels were similar between the groups (P>0.05).The incidence of thrombocytopenia [26.9%(14/52) vs.50.9%(28/55)],splenomegaly [23.8%(10/42) vs.61.5%(24/39)],and overall sentinel events[30.8%(16/52) vs.70.9%(39/55)]was significantly lower in the ≤34 μmol/L group (P<0.05).The liver transplantation rate at 2 years post-surgery was 3.7% (2/54) in the ≤34 μmol/L group,compared to 26.2% (16/61) in the >34 μmol/L group.Conclusions Elevated serum bile acid levels at 6 months post-Kasai procedure suggest a potential for poorer prognosis in children with BA who initially achieve jaundice resolution.
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备注/Memo
收稿日期:2024-5-26。
基金项目:国家自然科学基金(82270541);上海市临床重点专科(shslczdzk05703)
通讯作者:郑珊,Email:szheng@shmu.edu.cn