Zheng Lulu,Wu Yibo,Wu Wei,et al.Middle/long-term prognosis and influencing factors of Kasai portoenterostomy on type Ⅲ biliary atresia[J].Journal of Clinical Pediatric Surgery,2023,22(11):1045-1049.[doi:10.3760/cma.j.cn101785-202203017-008]
Ⅲ型胆道闭锁Kasai手术后患儿自体肝中长期生存情况的影响因素分析
- Title:
- Middle/long-term prognosis and influencing factors of Kasai portoenterostomy on type Ⅲ biliary atresia
- Keywords:
- Biliary Atresia; Prognosis; Root Cause Analysis; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨Ⅲ型胆道闭锁(biliary atresia,BA)Kasai手术后中长期生存情况,并分析其影响因素。方法 回顾性分析2011年1月至2020年12月上海市儿童医院确诊为Ⅲ型BA并行Kasai手术患儿的临床资料,包括性别、术前肝功能及血常规、术前巨细胞病毒免疫球蛋白M(immunoglobulin M,IgM)水平、手术时年龄及术后6个月内退黄情况。手术时年龄≤60 d定义为早期手术组,>60 d定义为晚期手术组;采用免疫酶联反应法检测巨细胞病毒IgM抗体,并根据检测结果分为IgM阳性组和IgM阴性组;谷草转氨酶和血小板比值(aspartate aminotransferase-to-platelet ratio index,APRi)=谷草转氨酶×谷草转氨酶正常值上限-1×100×血小板数-1(计量单位:109/L),谷草转氨酶和血小板均为Kasai手术前1周内同一次采血结果,分为APRi值<0.6组和APRi值≥0.6组;Kasai手术后6个月内总胆红素水平至少1次小于2 mg/dL定义为退黄组,其余定义为非退黄组。采用Kaplan-Meier法计算BA患儿5年、10年自体肝生存率;BA患儿预后相关因素的单因素分析采用Log-rank检验,多因素分析采用Cox回归。结果 本研究共获取234例Ⅲ型BA患儿资料;男118例,女116例;手术时日龄(72.7±23.0)d;Kasai手术后5年、10年自体肝生存率分别为41.2%和38.9%。单因素分析结果显示:患儿性别、巨细胞病毒IgM抗体阳性、APRi值均不影响BA患儿Kasai手术后中长期生存情况(P>0.05);手术时年龄、术后6个月退黄率是BA患儿Kasai手术后中长期生存情况的影响因素(P<0.05)。多因素Cox回归分析结果显示:术后6个月退黄情况是Kasai手术后自体肝中长期生存情况的独立影响因素(HR=0.190,95%CI:0.125~0.291,P<0.05)。结论 Kasai手术通过重建胆道来引流胆汁,是治疗BA的首选手术方式之一。BA患儿Kasai手术后6个月内退黄情况是自体肝中长期生存情况的独立影响因素。
- Abstract:
- Objective To explore the middle/long-term native liver survival and examine its influencing factors of Kasai portoenterostomy for type Ⅲ biliary atresia (BA).Methods From January 2011 to December 2020,single-center retrospective analysis was performed for 234 type Ⅲ BA children undergoing Kasai portoenterostomy.Gender,operative age,liver function test,blood routine test,cytomegalovirus (CMV) IgM examination and aspartate aminotransferase-to-platelet ratio index (APRi) were recorded.Operative age ≤eerativewas defined as early operation group while operative age >60 days as late operation group.IgM antibodies against CMV were detected by immunoenzyme-linked reaction.They were assigned into two groups of IgM positive and IgM negative according to the detection results.Ratio index of aspartate aminotransferase-to-platelet=AST/(upper limit of AST) ×100/PLT(109/L).Aspartate aminotransferase and platelets were measured at the same time 1 week pre-Kasai.They were divided into two groups of APRi <0.6 and APRi of.Total bilirubin ≤2 mg/dL being more than once post-Kasai within 6 mouths was defined as jaundice-eliminating group and the rest as jaundice group.And 5/10-year native liver survival was calculated by Kaplan Meier method.Univariate analysis was performed by Log rank test and multibariate analysis by Cox regression.Results There were 118 boy and 116 girls with an average operative age of (72.7±23) days.The 5/10-year native liver survival rate was 41.2% and 38.9% respectively.Univariate Kaplan-Meier liver survival and Log Rank test analysis revealed that gender (χ2=0.01,P=0.91),CMV (χ2=1.3,P=0.25) and APRi (χ2=0,P=0.98) had no effect on native liver survival.Compared with late operative age group,native liver survival rate spiked markedly in early operative age group (χ2=7.6,P=0.006).Compared with total bilirubin level greater than or equal to 2 mg/dL,native liver survival rate rose significantly in <2 mg/dL of total bilirubin (χ2=74.6,P=<0.001).Multivariate Cox regression analysis showed that only total bilirubin <2 mg/dL within 6 months post-Kasai was an independent influencing factor of middle/long-term liver survival.Conclusions Total bilirubin <2 mg/dL within 6 months after Kasai portoenterostomy is an independent influencing factor of middle/long-term liver survival.
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备注/Memo
收稿日期:2022-3-7。
基金项目:上海市儿童医院院级课题临床研究培育专项(2021YLYM02)
通讯作者:吴一波,Email:yibo_wu1007@163.com