Pediatric Surgery, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
Transpl Int. 2012 Oct;25(10):1041-9. doi: 10.1111/j.1432-2277.2012.01529.x. Epub 2012 Jul 21.
In children, optimal timing of liver transplantation (LT) is crucial, but reliable prognostic tools for chronic liver diseases are scarce. We assessed the predictive value of galactose half-life (Gal½) for LT or death. A retrospective search of hospital database 2003-2010 revealed 92 consecutive children with chronic liver disease (36 biliary atresia) whose liver function was assessed with Gal½ measurement. Gal½, follow-up data, and liver biochemistry were recorded and pediatric/model for end-stage liver disease (P/MELD) scores calculated. Patients listed for LT or those who died within 1 year of the Gal½ measurement (Group 1) were compared to those surviving without listing (Group 2). Predictive value of Gal½ and P/MELD for listing for LT was assessed with area under the receiver operating characteristic curve (AUROC) analysis. Group 1 had markedly increased median Gal½ [17.0 (interquartile range 12.5-28.5) min] and higher P/MELD [13 (-1-23)] compared with group 2, [10.5 (9.5-12.5) min and -1 (-8-8); P < 0.001 for both]. Both Gal½ and P/MELD (P < 0.001) predicted listing or death with respective AUROCs of 0.808 (95% CI 0.704-0.913) and 0.780 (0.676-0.890), and 85% sensitivity and 69% specificity for Gal½≥12.0 min. Gal½ is a useful tool when evaluating 1-year prognosis in children with chronic liver disease.
在儿童中，肝移植（LT）的最佳时机至关重要，但慢性肝病的可靠预后工具却很少。我们评估了半乳糖半衰期（Gal½）对 LT 或死亡的预测价值。对 2003-2010 年医院数据库的回顾性搜索显示，92 例连续患有慢性肝病（36 例胆道闭锁）的儿童进行了 Gal½测量以评估其肝功能。记录 Gal½、随访数据和肝功能检查，并计算小儿终末期肝病模型（PEDS-MELD）评分。将 LT 列入名单或 Gal½测量后 1 年内死亡的患者（第 1 组）与未列入名单但存活的患者（第 2 组）进行比较。用受试者工作特征曲线（ROC）分析评估 Gal½和 PEDS-MELD 对 LT 列入名单的预测价值。第 1 组的 Gal½中位数明显升高[17.0（12.5-28.5）分钟]，PEDS-MELD 评分也较高[13（-1-23）]，与第 2 组相比，[10.5（9.5-12.5）分钟和-1（-8-8）；P<0.001]。Gal½和 PEDS-MELD（P<0.001）均能预测列入名单或死亡，各自的 ROC 曲线下面积（AUC）为 0.808（95%CI 0.704-0.913）和 0.780（0.676-0.890），Gal½≥12.0 分钟的敏感性为 85%，特异性为 69%。Gal½是评估慢性肝病儿童 1 年预后的有用工具。
