Population, Policy & Practice Department, UCL GOS Institute of Child Health, London, UK
Population, Policy & Practice Department, UCL GOS Institute of Child Health, London, UK.
Arch Dis Child. 2023 Jun;108(6):468-473. doi: 10.1136/archdischild-2022-324946. Epub 2023 Feb 16.
The aim of this study was to investigate tested methods of population-based biliary atresia (BA) screening.
We searched 11 databases between 1 January 1975 and 12 September 2022. Data extraction was independently done by two investigators.
Our primary outcomes were: sensitivity and specificity of screening method in BA detection, age at Kasai, BA associated morbidity and mortality, cost-effectiveness of screening.
Six methods of BA screening were evaluated: stool colour charts (SCCs), conjugated bilirubin measurements, stool colour saturations (SCSs), measurements of urinary sulfated bile acids (USBAs), assessments of blood spot bile acids and blood carnitine measurements.In a meta-analysis, USBA was the most sensitive and specific, with a pooled sensitivity and specificity of 100.0% (95% CI 2.5% to 100.0%) and 99.5% (95% CI 98.9% to 99.8%) (based on one study). This was followed by conjugated bilirubin measurements: 100.0% (95% CI 0.0% to 100.0%) and 99.3% (95% CI 91.9% to 99.9%), SCS: 100.0% (95% CI 0.00% to 100.0%) and 92.4% (95% CI 83.4% to 96.7%), and SCC: 87.9% (95% CI 80.4% to 92.8%) and 99.9% (95% CI 99.9% to 99.9%).SCC reduced the age of Kasai to ~60 days, compared with 36 days for conjugated bilirubin. Both SCC and conjugated bilirubin improved overall and transplant-free survival. The use of SCC was considerably more cost-effective than conjugated bilirubin measurements.
Conjugated bilirubin measurements and SCC are the most researched and demonstrate improved sensitivity and specificity in detecting BA. However, their use is expensive. Further research into conjugated bilirubin measurements, as well as alternative methods of population-based BA screening, is required.
CRD42021235133.
本研究旨在探讨基于人群的胆道闭锁（BA）筛查的检测方法。
我们于 1975 年 1 月 1 日至 2022 年 9 月 12 日期间检索了 11 个数据库。数据提取由两名研究员独立完成。
我们的主要结局指标为：筛查方法在 BA 检测中的敏感性和特异性、行葛西术的年龄、BA 相关发病率和死亡率、筛查的成本效益。
评估了 6 种 BA 筛查方法：粪便颜色图表（SCCs）、结合胆红素测量、粪便颜色饱和度（SCSs）、尿硫酸化胆汁酸测量（USBAs）、血斑胆汁酸评估和血肉碱测量。在荟萃分析中，USBA 是最敏感和最特异的，灵敏度和特异性的合并值分别为 100.0%（95%CI 2.5%至 100.0%）和 99.5%（95%CI 98.9%至 99.8%）（基于一项研究）。其次是结合胆红素测量：100.0%（95%CI 0.0%至 100.0%）和 99.3%（95%CI 91.9%至 99.9%），SCS：100.0%（95%CI 0.00%至 100.0%）和 92.4%（95%CI 83.4%至 96.7%），SCC：87.9%（95%CI 80.4%至 92.8%）和 99.9%（95%CI 99.9%至 99.9%）。SCC 将葛西术的年龄降低至约 60 天，而结合胆红素为 36 天。SCC 和结合胆红素均改善了总体生存率和无移植生存率。SCC 的使用比结合胆红素测量更具成本效益。
结合胆红素测量和 SCC 是研究最多的方法，在检测 BA 方面显示出更高的敏感性和特异性。然而，它们的使用成本较高。需要进一步研究结合胆红素测量以及替代的基于人群的 BA 筛查方法。
PROSPERO 注册号：CRD42021235133。
