Hahn Seung Min, Kim Seung, Park Kook In, Han Seok Joo, Koh Hong
Department of Pediatrics, Yonsei University College of Medicine, Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Seoul, Korea.
PLoS One. 2013 Nov 18;8(11):e80652. doi: 10.1371/journal.pone.0080652. eCollection 2013.
The progression of hepatic fibrosis may result in decompensated hepatic failure with cirrhosis, liver related events (LRE) such as ascites, variceal bleeding, and death after successful and timely Kasai hepatoportoenterostomy (HPE) in biliary atresia. The aim of this study is to suggest clinical benefit of the liver stiffness measurement (LSM) using transient elastography at 3 months after the Kasai operation to predict LRE.
Between January 2007 and December 2011, 69 eligible biliary atresia patients who underwent Kasai HPE and performed transient elastography before and 3 months after HPE were included. The occurrences of LRE were analyzed for all patients. All patients were divided into 2 groups (with and without LRE) for comparison. Multivariate analysis was used to detect the independent risk factors of LRE. The area under the receiver operation characteristics curve (AUROC) was used to establish the LSM optimal cutoff value of 3 months after Kasai operation in predicting LRE.
LSM value, aminotransferase, albumin, bilirubin, and PT-INR significantly differed among the two groups. Multivariate analysis demonstrated LSM value as the most powerful independent factor of the development of LRE. The cut-off value of 19.9 kPa was calculated to be optimal for predicting LRE development with total sensitivity and specificity of 1.804. AUROC resulted in 0.943, with sensitivity of 85.3% and specificity of 95.2%.
The LSM value of 3 months after Kasai HPE can be a useful predictor of LRE development.
肝纤维化的进展可能导致失代偿期肝衰竭伴肝硬化，以及诸如腹水、静脉曲张破裂出血等肝脏相关事件（LRE），并导致胆道闭锁患者在成功及时地进行 Kasai 肝门肠吻合术（HPE）后死亡。本研究的目的是表明在 Kasai 手术后 3 个月使用瞬时弹性成像进行肝脏硬度测量（LSM）以预测 LRE 的临床益处。
纳入 2007 年 1 月至 2011 年 12 月期间 69 例符合条件的接受 Kasai HPE 并在 HPE 前及术后 3 个月进行瞬时弹性成像的胆道闭锁患者。分析所有患者 LRE 的发生情况。将所有患者分为两组（有和无 LRE）进行比较。采用多变量分析检测 LRE 的独立危险因素。使用受试者操作特征曲线下面积（AUROC）确定 Kasai 手术后 3 个月预测 LRE 的 LSM 最佳临界值。
两组间 LSM 值、转氨酶、白蛋白、胆红素和 PT-INR 有显著差异。多变量分析表明 LSM 值是 LRE 发生的最有力独立因素。计算得出 19.9 kPa 的临界值最适合预测 LRE 的发生，总敏感性和特异性为 1.804。AUROC为 0.943，敏感性为 85.3%，特异性为 95.2%。
Kasai HPE 术后 3 个月的 LSM 值可作为 LRE 发生的有用预测指标。
