Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima city, 890-8520, Japan.
Department of Pediatric Surgery, Kurume University of School of Medicine, Kurume, Japan.
Pediatr Surg Int. 2022 Dec;38(12):1777-1783. doi: 10.1007/s00383-022-05231-x. Epub 2022 Sep 13.
Various prognostic predictors for biliary atresia (BA) have been identified. This study aimed to evaluate the serial changes in the preoperative and postoperative ubiquitous inflammatory biomarkers and their relationship with the outcomes in patients with BA.
Forty-three BA patients were retrospectively reviewed to investigate serial levels of ubiquitous inflammatory biomarkers, including C-reactive protein (CRP) and lymphocyte ratio, and outcomes. The patients with BA were divided based on their outcomes into two prognostic groups: the native liver survivor group (n = 30) and the survivors with living-donor liver transplant group (n = 13).
The area under the receiver operating characteristic (ROC) curve analysis showed that a preoperative lymphocyte ratio of < 61% and CRP value > 0.1 mg/dl predicted a poor outcome. In the ROC curve analysis, the timing of reaching the cut-off value of CRP after Kasai portoenterostomy was postoperative day (POD) 57. The third postoperative week, which was the timing of the discontinuation of steroid therapy, was the branchpoint of inflammatory markers between the two prognostic groups.
The POD 57 CRP level predicts the surgical outcome of Kasai portoenterostomy. The postoperative anti-inflammatory management of BA can be monitored by the ubiquitous inflammatory biomarkers CRP and the preoperative lymphocyte ratio.
已经确定了各种用于胆道闭锁 (BA) 的预后预测因子。本研究旨在评估 BA 患者术前和术后普遍存在的炎症生物标志物的系列变化及其与结局的关系。
回顾性分析了 43 例 BA 患者的普遍炎症生物标志物（包括 C 反应蛋白 (CRP) 和淋巴细胞比值）和结局的连续水平。根据结局将 BA 患者分为两个预后组：未行肝移植的存活者组（n = 30）和行活体肝移植的存活者组（n = 13）。
受试者工作特征 (ROC) 曲线分析的曲线下面积显示，术前淋巴细胞比值<61%和 CRP 值>0.1 mg/dl 预测结局不良。在 ROC 曲线分析中，Kasai 胆肠吻合术后达到 CRP 临界值的时间为术后第 57 天。术后第 3 周，即停止类固醇治疗的时间点，是两个预后组之间炎症标志物的分支点。
第 57 天 CRP 水平预测了 Kasai 胆肠吻合术的手术结局。BA 的术后抗炎治疗可以通过普遍存在的炎症生物标志物 CRP 和术前淋巴细胞比值进行监测。
