Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China.
Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China.
Pediatr Surg Int. 2023 Jan 22;39(1):87. doi: 10.1007/s00383-023-05373-6.
Patients with choledochal cyst (CDC) develop liver fibrosis, especially advanced fibrosis without prompt surgery. This study validated the aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and Fibrosis-4 index (FIB-4) and constructed a model for predicting advanced fibrosis in pediatric CDCs.
Between January 2020 and March 2022, 330 CDCs (advanced fibrosis: 34, Ludwig staging 3-4; non-advanced fibrosis: 296, Ludwig staging 0-2) were reviewed. APRI and FIB-4 were validated. The area under the receiver operating characteristic (AUROC) curve was used to assess discrimination. Relevant variables were analyzed by backward stepwise logistic regression. Enhanced bootstrap method was used for internal verification with 1000 samples.
The AUROCs of APRI and FIB-4 were 0.761 (0.673-0.850) and 0.561 (0.455-0.667). AST to prealbumin ratio (APAR), was constructed with an AUROC of 0.776 (0.693-0.860). The AUROCs of APAR + APRI and APAR + FIB-4 were 0.791 (0.713-0.869) and 0.782 (0.699-0.865). No significant differences were noted in the AUROCs of the indices or their combinations. APAR and APRI could be used together to reduce missed diagnosis rate. The risk of advanced fibrosis varied from different APAR and APRI scores.
Both APAR and APRI were indispensable to identify CDC patients at high risk of advanced fibrosis.
胆总管囊肿（CDC）患者会发生肝纤维化，尤其是在没有及时手术的情况下会发生进展性纤维化。本研究旨在验证天门冬氨酸氨基转移酶（AST）与血小板比值指数（APRI）和纤维化-4 指数（FIB-4），并构建一个预测小儿 CDC 进展性纤维化的模型。
回顾性分析 2020 年 1 月至 2022 年 3 月间 330 例 CDC（进展性纤维化：34 例，Ludwig 分期 3-4 级；非进展性纤维化：296 例，Ludwig 分期 0-2 级）患者。验证 APRI 和 FIB-4，并采用受试者工作特征（ROC）曲线下面积（AUROC）评估其诊断价值。采用向后逐步逻辑回归分析相关变量。采用增强 bootstrap 法进行内部验证，重复 1000 次。
APRI 和 FIB-4 的 AUROC 分别为 0.761（0.673-0.850）和 0.561（0.455-0.667）。AST 与前白蛋白比值（APAR）的 AUROC 为 0.776（0.693-0.860）。APAR+APRI 和 APAR+FIB-4 的 AUROC 分别为 0.791（0.713-0.869）和 0.782（0.699-0.865）。各指标或组合的 AUROC 之间无显著差异。APAR 和 APRI 可联合使用以降低漏诊率。不同的 APAR 和 APRI 评分提示着不同的进展性纤维化风险。
APAR 和 APRI 均有助于识别发生进展性肝纤维化的 CDC 患者。
