Department of Pediatric Surgery, Kings College Hospital, London, SE5 9RS, UK.
Department of Pediatric Surgery, Kings College Hospital, London, SE5 9RS, UK.
J Pediatr Surg. 2023 Dec;58(12):2347-2351. doi: 10.1016/j.jpedsurg.2023.06.012. Epub 2023 Jun 28.
The outcomes following surgical treatment of infants with biliary atresia (BA) varies across the world with many possible confounding factors. APRi (AST-to-platelet ratio index) is a simple surrogate marker of liver fibrosis and we sought to determine its long-term relationship (if any) with outcome post-Kasai portoenterostomy (KPE).
Prospectively acquired database (Jan 1998-Dec 2021). Clearance of jaundice was defined as achieving <20 umol/L post-KPE. Categorical and survival data were tested using Chi tests and a log rank test respectively. P ≤ 0.05 was regarded as significant. Data are quoted as median (interquartile range) unless otherwise stated.
There were 473 infants with a calculated APRi at time of KPE [0.70 (IQR 0.45-1.2)] and known outcomes. There was significant but moderate correlation with age at KPE (r = 0.43; P < 0.0001). APRi was divided into quartiles (1st 0.11-0.44, n = 120; 2nd 0.45-0.69, n = 120; 3rd 0.70-1.18, n = 115 and 4th 1.2-15.1; n = 118). There was a clear distinction in APRi levels between CMV + ve BA and the other groups (Syndromic BA, Cystic BA, Isolated BA), with an overrepresentation of CMV IgM + ve BA in the higher APRi quartiles (Χ = 26.6; P = 0.0002). Clearance of jaundice showed a stepwise decrease across the quartiles (67%; 58%; 55%; 49%; overall Χ = 7.8, P = 0.049 and P = 0.005 for trend). Decreasing native liver survival also showed a significant trend (P = 0.01).
APRi appears to be of fundamental prognostic value in stratifying the BA population. In our series, CMV status was associated with higher APRi score and appears to be different. This simple variable offers an objective method of assessing the biological status of BA at presentation and variability between different series.
II (prospective comparison).
胆道闭锁（BA）患儿的手术治疗结果在全球范围内存在差异，可能存在许多混杂因素。APRi（AST 与血小板比值指数）是肝纤维化的简单替代标志物，我们试图确定其与 Kasai 门腔分流术后（KPE）结果的长期关系（如果有的话）。
前瞻性获取数据库（1998 年 1 月至 2021 年 12 月）。KPE 后黄疸消退定义为胆红素值<20umol/L。使用卡方检验和对数秩检验分别测试分类和生存数据。P≤0.05 被认为具有统计学意义。数据以中位数（四分位间距）表示，除非另有说明。
473 例婴儿在 KPE 时计算了 APRi[0.70（IQR 0.45-1.2）]，且具有已知的结果。APRi 与 KPE 时的年龄呈显著但中度相关（r=0.43；P<0.0001）。APRi 分为四分位数（1 四分位数 0.11-0.44，n=120；2 四分位数 0.45-0.69，n=120；3 四分位数 0.70-1.18，n=115 和 4 四分位数 1.2-15.1，n=118）。CMV 阳性 BA 与其他各组（综合征性 BA、囊性 BA、孤立性 BA）的 APRi 水平存在明显差异，CMV IgM 阳性 BA 在较高 APRi 四分位数中更为常见（Χ=26.6；P=0.0002）。黄疸消退率随四分位数呈阶梯式下降（67%；58%；55%；49%；总体Χ=7.8，P=0.049 和 P=0.005 呈趋势）。原代肝存活率的降低也呈显著趋势（P=0.01）。
APRi 似乎对 BA 人群的分层具有基本的预后价值。在我们的系列中，CMV 状态与较高的 APRi 评分相关，且似乎不同。这种简单的变量提供了一种评估 BA 患者在就诊时生物学状态的客观方法，并且在不同系列之间具有变异性。
II（前瞻性比较）。
