Guo Shuoshuo,Zeng Jixiao,Xu Xiaogang,et al.Analysis of short/medium-term efficacies and influencing factors in biliary atresia infants with a low level of γ-glutamyl transferase[J].Journal of Clinical Pediatric Surgery,2026,(03):243-248.[doi:10.3760/cma.j.cn101785-202505005]
低水平γ-谷氨酰转肽酶胆道闭锁患儿Kasai术后近中期疗效及影响因素分析
- Title:
- Analysis of short/medium-term efficacies and influencing factors in biliary atresia infants with a low level of γ-glutamyl transferase
- Keywords:
- γ-Glutamyl Transferase; Biliary Atresia; Surgical Procedures; Operative; Prognosis; Root Cause Analysis
- 摘要:
- 目的 探讨术前γ-谷氨酰转肽酶(γ-glutamyl transferase,γ-GGT)＜300 IU/L的胆道闭锁(biliary atresia,BA)患儿Kasai术后近中期疗效及预后影响因素。方法 回顾性分析2016年6月至2023年10月在广州医科大学附属妇女儿童医疗中心接受Kasai手术的BA患儿临床资料,以术前γ-GGT 300 IU/L为截断值,分为低水平γ-GGT(Low γ-glutamyl transferase,LG)组(＜300 IU/L,51例)与高水平γ-GGT(High γ-glutamyl transferase,HG)组(≥300 IU/L,124例)。在LG组内,按术后结局分为自体肝生存组与肝移植/死亡组,对比两组一般情况、术前肝功能指标、术后胆管炎发生情况及早期胆汁引流效果;再按手术日龄60天分层,比较不同手术日龄组的低水平γ-GGT组与高水平γ-GGT组的自体肝生存时间;进一步分析不同手术日龄低水平γ-GGT亚组内自体肝生存组与肝移植/死亡组的临床及围术期指标差异。结果 LG组Kasai术后6个月、1年、3年及5年自体肝生存率(survival rate of native liver,SNL)分别为62.7%、41.2%、28.2%、28.2%;HG组分别为69.4%、54.0%、45.2%、37.8%;两组总体生存曲线比较,差异无统计学意义(Log-rank χ2=1.86,P＞0.05)。LG组内,自体肝生存组手术日龄显著低于肝移植/死亡组[(55.80±12.35)d比(71.28±15.36)d],早期胆汁引流良好率显著高于肝移植/死亡组(9/15比2/36),差异均有统计学意义(P＜0.05)。手术日龄≤60天组中,低水平γ-GGT组与高水平γ-GGT组自体肝生存率差异无统计学意义(P＞0.05);在手术日龄≤60天的低水平γ-GGT亚组内,自体肝生存组与肝移植/死亡组各个指标差异无统计学意义(P＞0.05)。手术日龄＞60天组中,低水平γ-GGT组5年SNL(15%)显著低于高水平γ-GGT组(32.3%),差异有统计学意义(Log-rank χ2=4.12,P＜0.05)。在手术日龄＞60天的低水平γ-GGT亚组内,自体肝生存组早期胆汁引流良好率显著高于肝移植/死亡组(4/5比1/25),差异有统计学意义(P＜0.001),其余指标差异无统计学意义(P＞0.05)。结论 低水平γ-GGT的BA患儿,手术日龄超过60天者预后差于高水平γ-GGT患儿;早期胆汁引流成功是改善该类患儿预后的关键。
- Abstract:
- Objective To explore the short/medium-term efficacies and prognostic factors of Kasai operation in infants with biliary atresia (BA) and a low preoperative level of γ-glutamyl transferase (γ-GGT) (<300 IU/L).Methods A retrospective review was conducted for the relevant clinical data of BA infants undergoing Kasai portoenterostomy at Guangzhou Women and Childrens Medical Center from June 2016 to October 2023.Based upon a preoperative serum γ-glutamyl transferase (γ-GGT) cutoff level of 300 IU/L,they were stratified into two groups of low γ-GGT (<300 IU/L,n=51) and high γ-GGT (≥300 IU/L,n=124) for comparing their prognoses.Based upon postoperative outcomes,LG group was further categorized into two subgroups of native liver survival and liver transplantation/death.General profiles,preoperative liver function parameters,incidence of postoperative cholangitis and early bile drainage efficacy were compared between these two subgroups.Subsequently,they were stratified by surgical age (60 days) for comparing native liver survival time between LG and HG groups within each age stratum.Furthermore,differences in clinical and perioperative indicators between native liver survival and liver transplantation/death subgroups were examined within LG subgroups of different surgical ages.Results The 6-month and 1/3/5-year survival rates of native liver after Kasai portoenterostomy were 62.7%,41.2%,28.2% and 28.2% in LG group and 69.4%,54.0%,45.2% and 37.8% in HG group.No statistically significant inter-group difference existed in overall survival curves (Log-rank χ2=1.86,P>0.05).Within LG group,surgical age was significantly lower in native liver survival subgroup than that in liver transplantation/death subgroup[(55.80±12.35) vs.(71.28±15.36) day,P＜0.05].Rate of successful early bile drainage was significantly higher in native liver survival subgroup(9/15 vs. 21/26,P＜0.05).Among those with surgical age ≤60 days,no significant difference existed in survival rate of native liver between LG and HG groups (P>0.05).Furthermore,within LG subgroup with surgical age ≤60 days,no significant differences existed in any measured indicator between native liver survival and liver transplantation/death subgroups (P>0.05).In subgroup with surgical age >60 days,5-year SNL was significantly lower in LG group than that in HG group (15% vs.32.3%).The difference was statistically significant (Log-rank χ2= 4.12,P<0.05).Within LG subgroup with surgical age >60 days,rate of successful early bile drainage was significantly higher in native liver survival subgroup than liver transplantation/death subgroup (4/5 vs. 1/25,P<0.001).No significant differences existed in the remaining indicators between these two subgroups (P>0.05). Conclusions For BA infants with a low level of γ-GGT,those with surgical age >60 days have a worse prognosis than those with a high level of γ-GGT.And successful early bile drainage is an important factor for a better prognosis.
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备注/Memo
收稿日期:2025-5-5。
基金项目:国家自然科学基金(82170528);广州地区临床特色技术项目(2023C-TS48);广州市科技计划市校(院)企联合资助项目(2024A03J1236)
通讯作者:刘斐,Email:star5044207@163.com