Han Yijiang,Wu Hao,Ji Haosen,et al.Correlation between age of Kasai portoenterostomy and early prognosis for biliary atresia[J].Journal of Clinical Pediatric Surgery,2023,22(03):225-231.[doi:10.3760/cma.j.cn101785-202210044-005]
胆道闭锁Kasai手术日龄与早期预后的关联性分析
- Title:
- Correlation between age of Kasai portoenterostomy and early prognosis for biliary atresia
- Keywords:
- Biliary Atresia; Prognosis; Liver Function Test; Operative Age
- 摘要:
- 目的 探讨胆道闭锁(biliary atresia,BA) Kasai手术日龄与早期预后的关联性,为BA患儿Kasai手术时机提供参考。方法 采用回顾性研究方法,收集2019年1月至2021年12月浙江大学医学院附属儿童医院收治的BA患儿临床资料,包括一般资料(性别、手术时日龄)、肝功能、凝血功能及血氨指标。根据Kasai手术后3个月退黄情况分为未退黄组(n=47)和退黄组(n=66),计算手术时日龄的cut-off值;再根据此手术时日龄分为两组,比较Kasai手术后3个月的预后指标,包括碱性磷酸酶(alkaline phosphatase,ALP)、丙氨酸转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate aminotransferase,AST)、直接胆红素(direct bilirubin,DBIL)、术后DBIL/术前DBIL、γ-谷氨酰转移酶(gamma-glutamyltransferase,GGT)、总胆汁酸(total bile acid,TBA)、总胆红素(total bilirubin,TBIL)、血小板计数(platelet count,PLT)、天冬氨酸转氨酶与血小板比值指数(aspartate aminotransferase-to-platelet ratio index,APRI)、国际标准化比值(international normalized ratio,INR)。结果 共收集病例113例,男49例,女64例;手术日龄59.00(40.50,69.00) d。对未退黄组和退黄组的各项术前指标进行单因素分析,结果显示两组手术日龄[64(52,79) d比55(33,67) d]、AST[202.00(138.00,332.00) U/L比147.50(100.00,242.00) U/L]、间接胆红素(indirect bilirubin,IBIL)[(70.60±20.31)μmol/L比(79.96±27.13)μmol/L]、总蛋白(total protein,TP)[(55.88±6.59) g/L比(53.13±4.71) g/L]差异具有统计学意义(P＜0.05)。将单因素分析中P＜0.1的指标[手术时日龄、白蛋白(albumin,ALB)、ALT、AST、IBIL、TP、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)]纳入Logistic回归分析,结果显示手术时日龄(OR=0.974,95%CI:0.951~0.997,P=0.030)是Kasai手术后3个月退黄的独立影响因素。根据手术时日龄的cut-off值(46.5 d)分组,比较Kasai手术后3个月各项指标,结果显示手术时日龄≤46.5 d组的ALP[365.00(316.00,514.75) U/L比492.00(343.00,684.00) U/L]、ALT[(76.35±81.33) U/L比(134.09±97.45) U/L]、AST[67.50(41.50,99.50) U/L比112.00(79.00,168.00) U/L]、DBIL[2.55(1.78,6.95)μmol/L比9.80(3.60,36.80)μmol/L]、术后DBIL/术前DBIL[0.05(0.03,0.09)比0.12(0.05,0.54)]、TBA[45.50(25.93,92.93)μmol/L比106.20(41.20,187.50)μmol/L]、TBIL[9.65(6.98,15.43)μmol/L比21.50(10.40,66.90)μmol/L]及APRI[0.32(0.22,0.48)比0.62(0.41,0.93)]明显低于手术时日龄＞46.5 d组,差异具有统计学意义(P＜0.05)。结论 手术时日龄≤46.5 d组患儿早期预后指标较手术时日龄＞46.5 d组更好,尽早行Kasai手术可改善BA预后。
- Abstract:
- Objective To explore the correlation between age of Kasai portoenterostomy and early prognosis to provide references for timing of Kasai surgery in biliary atresia (BA) children.Methods Retrospective review was conducted for clinical data of hospitalized BA children from January 2019 to December 2021.General profiles (gender & operative age) and parameters of liver function,coagulation function and blood ammonia were collected.According to the jaundice clearance at 3 months post-operation,they were assigned into two groups of non-jaundice clearance (n=47) and jaundice clearance (n=66).The cut-off value of operative age was calculated.Then two groups were divided according to operative age.The prognostic parameters of Kasai portoenterostomy at 3 months post-operation were compared,including alkaline phosphatase (ALP),alanine aminotransferase (ALT),aspartate aminotransferase (AST),direct bilirubin (DBIL),postoperative DBIL/ preoperative DBIL,gamma-glutamyltransferase (GGT),total bile acid (TBA),total bilirubin (TBIL),platelet count (PLT),aspartate aminotransferase-to-platelet ratio index (APRI) and international normalized ratio (INR).Results A total of 113 cases were collected,including 49 males and 64 females. The operative age was 59.00 (40.50,69.00) days. Univariate analysis of the preoperative indexes of the non-jaundice clearance group and the jaundice clearance group showed that the age of operation(64 (52,79) d vs. 55 (33,67) d),AST (202.00 (138.00,332.00) U/L vs.147.50 (100.00,242.00) U/L),indirect bilirubin (IBIL) ((70.60±20.31)μmol/L vs.(79.96±27.13)μmol/L),total protein(TP) ((55.88±6.59)g/L vs.(53.13±4.71)g/L) between the two groups were statistically significant (P<0.05). The indexes with P<0.1 in univariate analysis [age of operation,albumin (ALB),ALT,AST,IBIL,TP,activated partial thromboplastin time(APTT)] were included in the multivariate Logistic regression analysis,and the results showed that the age of operation (OR=0.974,95%CI:0.951-0.997,P=0.030) was an independent factor influencing the jnundice clearance at 3 months after Kasai protoentrostomy. According to the cut-off value (46.5d) of the operative age group,the results showed that the levels of ALP(365.00 (316.00,514.75) U/L vs.492.00 (343.00,684.00) U/L),ALT ((76.35±81.33) U/L vs.(134.09±97.45)U/L),AST (67.50 (41.50,99.50) U/L vs.112.00 (79.00,168.00) U/L),DBIL (2.55 (1.78,6.95) μmol/L vs. 9.80 (3.60,36.80) μmol/L),postoperative DBIL/ preoperative DBIL(0.05 (0.03,0.09) vs.0.12 (0.05,0.54)),TBA (45.50 (25.93,92.93) μmol/L vs.106.20 (41.20,187.50) μmol/L),TBIL (9.65 (6.98,15.43) μmol/L vs.21.50 (10.40,66.90) μmol/L) and APRI (0.32 (0.22,0.48) vs.0.62 (0.41,0.93)) in the operation age ≤46.5 d group were significantly lower than those in the operation age > 46.5 d group, the difference was statistically significant (P<0.05).Conclusion Early prognostic parameters are superior in group with operative age≤46.5 days to group with operative age >46.5 days.And early Kasai portoenterostomy may improve the prognosis of BA.
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备注/Memo
收稿日期:2022-10-22。
基金项目:国家中心自主设计项目(S20C0004)
通讯作者:钭金法,Email:toujinfa@zju.edu.cn