血清总胆红素、丙氨酸转氨酶和γ-谷氨酰转移酶对Kasai 手术后胆道闭锁患者生存的影响。

The impact of serum total bilirubin, alanine transaminase and gamma-glutamyl transferase on survival of biliary atresia patients following Kasai procedure.

机构信息

Universitas Gadjah Mada, Public Health and Nursing, Faculty of Medicine, Department of Surgery, Pediatric Surgery Division, Yogyakarta, Indonesia.

Universitas Muhammadiyah Yogyakarta, Faculty of Medicine and Health Sciences, Indonesia.

出版信息

Med J Malaysia. 2020 May;75(Suppl 1):1-4.

PMID:32483103

Abstract

BACKGROUND

Many prognostic factors have been reported for the outcomes of biliary atresia (BA) patients after Kasai procedure, however, it still shows a conflicting result. Our study was to determine the impact of total bilirubin postoperative day-7 and pre-operative ratio (TB7/TB0), gammaglutamyl transferase post-operative day-7 and pre-operative ratio (GGT7/GGT0), and alanine transaminase post-operative day-7 and pre-operative ratio (ALT7/ALT0) on the survival of BA patients following Kasai surgery.

METHODS

We reviewed the medical records of BA patients who underwent Kasai procedure at the Dr. Sardjito Hospital, Indonesia from August 2012 to December 2018. The cut-off values of TB7/TB0, GGT7/GGT0, and ALT7/ALT0 for prediction of patients' survival were determined by receiver operating characteristics (ROC) curves. Log-rank tests were utilised to test the association between cut-off values and overall survival.

RESULTS

In all 46 BA patients (23 males and 23 females) after Kasai procedure were included, consisting of one type 1, 17 type 2A, seven type 2B, and 21 type 3. The cut-off values of TB7/TB0, ALT7/ALT0 and GGT7/GGT0 for overall survival was 0.455 (sensitivity 87.5%, specificity 22.7%, area under curve (AUC) 0.59; 95% Confidence Interval (95%CI): 0.42, 0.75), 0.481 (sensitivity 87.5%, specificity 18.2%, AUC 0.49; 95%CI: 0.31, 0.65), and and 0.31 (sensitivity 79.2%, specificity 9.1%, AUC 0.34; 95%CI: 0.18, 0.50), respectively. However, these cut-off values were not significantly associated with overall survival, with p-values of 0.18, 0.49, and 0.56, respectively.

CONCLUSION

The TB7/TB0, ALT7/ALT0, and GGT7/GGT0 might not predict the overall survival of BA patients after Kasai procedure. Further multicentre studies with a larger sample size is needed to clarify our findings.

摘要

背景

已有多项研究报道了用于预测胆道闭锁（BA）患儿行Kasai 手术后结局的预后因素，但结果仍存在争议。本研究旨在探讨术后第 7 天总胆红素（TB7/TB0）、γ-谷氨酰转肽酶（GGT7/GGT0）和丙氨酸氨基转移酶（ALT7/ALT0）比值对 BA 患儿行 Kasai 手术后生存的影响。

方法

回顾性分析 2012 年 8 月至 2018 年 12 月在印度尼西亚萨德尔丁医院接受 Kasai 手术的 BA 患儿的病历资料。通过受试者工作特征（ROC）曲线确定 TB7/TB0、GGT7/GGT0 和 ALT7/ALT0 的截断值，以预测患儿的生存情况。采用对数秩检验检测截断值与总生存时间的相关性。

结果

共纳入 46 例行 Kasai 手术的 BA 患儿（男 23 例，女 23 例），其中 1 型 1 例，2A 型 17 例，2B 型 7 例，3 型 21 例。TB7/TB0、ALT7/ALT0 和 GGT7/GGT0 预测总体生存的截断值分别为 0.455（敏感度 87.5%，特异度 22.7%，曲线下面积（AUC）为 0.59；95%可信区间（95%CI）：0.42，0.75）、0.481（敏感度 87.5%，特异度 18.2%，AUC 为 0.49；95%CI：0.31，0.65）和 0.31（敏感度 79.2%，特异度 9.1%，AUC 为 0.34；95%CI：0.18，0.50）。然而，这些截断值与总体生存时间均无显著相关性（p 值分别为 0.18、0.49 和 0.56）。