He Lin, Ip Dennis Kai Ming, Tam Greta, Lui Vincent Chi Hang, Tam Paul Kwong Hang, Chung Patrick Ho Yu
Department of Radiotherapy, Tangdu Hospital, Air Force Military Medical University, Xi'an, China.
School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, SAR.
Sci Rep. 2021 Jun 3;11(1):11692. doi: 10.1038/s41598-021-91072-y.
To evaluate the accuracy of biomarkers for the early diagnosis of biliary atresia (BA) and prognostic stratification after Kasai portoenterostomy (KPE). We conducted a systematic review of PubMed, Web of Science, Embase, Scopus and OVID for English literature reporting BA biomarkers published before August 2020. Screening, data extraction, and quality assessment were performed in duplicate. A total of 51 eligible studies were included in the systematic review, and data from 12 (4182 subjects) were extracted for meta-analysis regarding the following 2 domains: (1) serum matrix metallopeptidase-7 (MMP-7), interleukin33 (IL-33) and γ-glutamyl transferase (GGT) to differentiate BA from non-BA; (2) the aspartate aminotransferase to platelet ratio index (APRi) to predict post-KPE liver fibrosis/cirrhosis. The summary sensitivity, specificity and area under the curve (AUC) of MMP-7 for diagnosing BA were 96%, 91% and 0.9847, respectively, and those of GGT were 80%, 79% and 0.9645, respectively. The summary sensitivity and specificity of IL-33 for diagnosing BA were 77% and 85%, respectively. The summary sensitivity and specificity of APRi for predicting post-KPE liver fibrosis were 61% and 80%, respectively, and the summary sensitivity, specificity and AUC of APRi for predicting post-KPE cirrhosis were 78%, 83% and 0.8729, respectively. Moreover, good evidence was shown in investigations of serum IL-18 and IL-33 in distinguishing BA from healthy controls, serum IL-18 for prognosis of post-KPE persistent jaundice, and serum hyaluronic acid and MMP-7 for prognosis of post-KPE significant liver fibrosis. MMP-7, IL-33 and GGT are useful biomarkers to assist in the diagnosis of BA. APRi might be used to predict post-KPE significant liver fibrosis and cirrhosis. These noninvasive biomarkers can be integrated into the management protocol of BA.
评估生物标志物在胆道闭锁（BA）早期诊断及 Kasai 肝门空肠吻合术（KPE）后预后分层中的准确性。我们对 PubMed、Web of Science、Embase、Scopus 和 OVID 进行了系统综述，以查找 2020 年 8 月之前发表的报告 BA 生物标志物的英文文献。筛查、数据提取和质量评估均进行了两次。系统综述共纳入 51 项符合条件的研究，并从 12 项研究（4182 名受试者）中提取数据进行荟萃分析，涉及以下两个领域：（1）血清基质金属蛋白酶 -7（MMP -7）、白细胞介素 33（IL -33）和γ-谷氨酰转移酶（GGT）以区分 BA 和非 BA；（2）天冬氨酸转氨酶与血小板比值指数（APRi）以预测 KPE 后肝纤维化/肝硬化。MMP -7 诊断 BA 的汇总敏感性、特异性和曲线下面积（AUC）分别为 96%、91%和 0.9847，GGT 的分别为 80%、79%和 0.9645。IL -33 诊断 BA 的汇总敏感性和特异性分别为 77%和 85%。APRi 预测 KPE 后肝纤维化的汇总敏感性和特异性分别为 61%和 80%，APRi 预测 KPE 后肝硬化的汇总敏感性、特异性和 AUC 分别为 78%、83%和 0.8729。此外，血清 IL -18 和 IL -33 在区分 BA 与健康对照、血清 IL -18 对 KPE 后持续性黄疸预后、血清透明质酸和 MMP -7 对 KPE 后显著肝纤维化预后的研究中显示出有力证据。MMP -7、IL -33 和 GGT 是有助于 BA 诊断的有用生物标志物。APRi 可用于预测 KPE 后显著肝纤维化和肝硬化。这些非侵入性生物标志物可纳入 BA 的管理方案。
