Division of Gastroenterology and Hepatology.
Pediatric Liver Disease and Immunology STAR (Special Task Force for Activating Research), Department of Pediatrics.
J Pediatr Gastroenterol Nutr. 2019 Oct;69(4):411-415. doi: 10.1097/MPG.0000000000002430.
The aim of the study was to determine the accuracy of noninvasive parameters, such as liver (LS) and spleen stiffness (SS) to detect esophageal varices (EV) in children with biliary atresia (BA).
Children with BA between 2000 and 2015 were recruited. All underwent esophagogastroduodenoscopy and transient elastography. Demographic data, laboratory investigations, alanine transferase-to-platelet ratio index (APRI), and Varices Prediction Rule (VPR) score were collected.
A total of 51 children (mean age 10.63 years, standard deviation (SD) = 6.08 years; 53% boys) were enrolled. There were differences in onset and outcome of portoenterostomy, spleen palpablility, platelet count, albumin, LS, SS, and VPR between the varice and varice-free groups (P < 0.05). In the varice group, the median LS was 18.12 (interquartile ratio, IQR 13.15-19.12) and the median SS was 46.85 (IQR 25.95-54.55) kPa. In the varice-free group, the median LS was 7.85 (IQR 5.88-16.75) and the median SS was 16.54 (IQR 11.75-21.75) kPa. Both LS and SS were higher in the varice than the varice-free group (P < 0001). The area under the receiver operating characteristic curve of LS, SS, spleen palpability, platelet count, APRI, and VPR were 0.734, 0.870, 0.817, 0.810, 0.751, and 0.794, respectively. Using a cut-off value of 12.5 kPa for LS, the sensitivity and specificity were 80 and 70%, respectively. Using a cut-off value of 28.9 kPa for SS, the sensitivity and specificity were 75 and 87%, respectively. Combination of LS and SS to diagnose varices increased the specificity to 93%.
SS as a single marker had the best diagnostic value to predict esophageal varices in children with BA. The combination of SS and LS furthermore, increased the diagnostic yield.
本研究旨在确定非侵入性参数（如肝脏（LS）和脾脏硬度（SS））检测胆道闭锁（BA）患儿食管静脉曲张（EV）的准确性。
2000 年至 2015 年间招募 BA 患儿。所有患儿均行食管胃十二指肠镜检查和瞬时弹性成像检查。收集人口统计学数据、实验室检查、丙氨酸氨基转移酶与血小板比值指数（APRI）和静脉曲张预测规则（VPR）评分。
共纳入 51 例患儿（平均年龄 10.63 岁，标准差（SD）=6.08 岁；53%为男孩）。有静脉曲张组和无静脉曲张组之间的门腔分流术起始和结果、脾脏可触及性、血小板计数、白蛋白、LS、SS 和 VPR 存在差异（P＜0.05）。在静脉曲张组，中位数 LS 为 18.12（四分位距，IQR 13.15-19.12）kPa，中位数 SS 为 46.85（IQR 25.95-54.55）kPa。在无静脉曲张组，中位数 LS 为 7.85（IQR 5.88-16.75）kPa，中位数 SS 为 16.54（IQR 11.75-21.75）kPa。LS 和 SS 在静脉曲张组均高于无静脉曲张组（P＜0.0001）。LS、SS、脾脏可触及性、血小板计数、APRI 和 VPR 的受试者工作特征曲线下面积分别为 0.734、0.870、0.817、0.810、0.751 和 0.794。LS 的截断值为 12.5 kPa 时，灵敏度和特异度分别为 80%和 70%。SS 的截断值为 28.9 kPa 时，灵敏度和特异度分别为 75%和 87%。LS 和 SS 联合诊断静脉曲张可将特异性提高至 93%。
SS 作为单一标志物对预测 BA 患儿食管静脉曲张具有最佳诊断价值。SS 和 LS 的联合应用进一步提高了诊断效能。
