Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho Izumi, Osaka, 594-1101, Japan.
J Pediatr Surg. 2013 Dec;48(12):2373-7. doi: 10.1016/j.jpedsurg.2013.08.009.
BACKGROUND/PURPOSE: The purpose of this study was to determine reliable predictors of outcome of biliary atresia (BA) after Kasai's operation.
Fifty-four BA cases that underwent Kasai's operation at our institution over two decades were reviewed. The cases were divided into two groups: Group I: cases that required liver transplantation or died (n=30) and Group II: cases alive with the native liver. Serum levels of total bilirubin (TB), direct bilirubin (DB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT) were measured sequentially after surgery. For cut-off determination, receiver operating characteristic (ROC) analysis was employed.
Serum TB, DB, AST, and ALT in Group I were significantly higher than those in Group II at 1, 2, and 3 months after surgery (p<.05). The most reliable cut-offs determined by ROC analysis were DB of 0.7 mg/dl at 2 months (sensitivity; 93%, specificity; 75%) and AST of 94 IU/L at 2 months (sensitivity; 87%, specificity; 71%). The 54 cases were re-divided into three groups according to the cut-off values: group G (good) with DB and AST<cut-offs (n=16; Group I:II=1:15), group M (moderate) with DB or AST>cut-offs (n=9; Group I:II=4:5), and group P (poor) with DB and AST ≥ cut-offs (n=29; Group I:II=25:4). The 15-year survival rate in groups G, M, and P was 94%, 44%, and 22%, respectively (p<.001).
The combination of serum DB and AST at 2 months after Kasai's operation is a reliable predictor of long-term BA outcome.
背景/目的：本研究旨在确定胆道闭锁（BA）Kasai 手术后结局的可靠预测因素。
回顾了 20 多年来在我院接受 Kasai 手术的 54 例 BA 病例。将这些病例分为两组：I 组：需要肝移植或死亡的病例（n=30）和 II 组：存活且具有原生肝脏的病例。手术后连续测量血清总胆红素（TB）、直接胆红素（DB）、天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）和γ-谷氨酰转移酶（GGT）的水平。为了确定截断值，采用了受试者工作特征（ROC）分析。
术后 1、2 和 3 个月，I 组的血清 TB、DB、AST 和 ALT 明显高于 II 组（p<.05）。ROC 分析确定的最可靠截断值为 2 个月时 DB 为 0.7mg/dl（灵敏度为 93%，特异性为 75%）和 AST 为 94IU/L（灵敏度为 87%，特异性为 71%）。根据截断值，54 例病例进一步分为三组：DB 和 AST<截断值的 G 组（良好）（n=16；I 组：II 组=1:15）、DB 或 AST>截断值的 M 组（n=9；I 组：II 组=4:5）和 DB 和 AST≥截断值的 P 组（n=29；I 组：II 组=25:4）。G、M 和 P 组的 15 年生存率分别为 94%、44%和 22%（p<.001）。
Kasai 手术后 2 个月时血清 DB 和 AST 的联合是长期 BA 结局的可靠预测因素。
