Yokoyama Shinya, Ishizu Yoji, Honda Takashi, Imai Norihiro, Ito Takanori, Yamamoto Kenta, Muto Hisanori, Shirota Chiyoe, Tainaka Takahisa, Sumida Wataru, Makita Satoshi, Takada Shunya, Nakagawa Yoichi, Maeda Takuya, Nakamura Masanao, Ishigami Masatoshi, Uchida Hiroo, Kawashima Hiroki
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Hepatol Res. 2024 Apr;54(4):347-357. doi: 10.1111/hepr.13976. Epub 2023 Oct 25.
Biliary atresia (BA) is a congestive biliary disease that develops in the neonatal period or early infancy. It may present with portal hypertension and varices needing treatment (VNT) even after successful Kasai portoenterostomy. This study aimed to stratify the risk of VNT in children and adolescents with BA.
In this prospective cross-sectional study, we measured liver stiffness (LS) and spleen stiffness (SS) by two-dimensional shear wave elastography and checked for VNT endoscopically in 53 patients with BA who attended for follow-up between July 2018 and September 2022. Varices needing treatment were defined as large esophageal varices, esophageal varices of any size with red color signs, and/or gastric varices along the cardia.
Twenty-five patients (aged 0-18 years) had VNT. Eighteen patients met the Baveno VI criteria (LS <20 kPa; platelet count >150 000/L) and were deemed to be at low risk of VNT (spared endoscopies) while three had missed VNT (16.7%). Applying the Baveno VII criteria, which combines the SS cut-off value of 40 kPa with the Baveno VI criteria, resulted in five missed VNTs among 22 spared endoscopies (22.7%). A modification of the Baveno VII criteria using the aspartate aminotransferase-to-platelet ratio index (APRI) instead of the platelet count with cut-off values of 25 kPa, 30 kPa, and 1.04 for LS, SS, and APRI, respectively, missed only one VNT (5.0%) among 20 spared endoscopies.
A novel diagnostic criterion that combines LS, SS, and APRI reduced the risk of missing VNT to 5% in children and adolescents with BA.
胆道闭锁（BA）是一种在新生儿期或婴儿早期发生的阻塞性胆道疾病。即使在成功进行Kasai肝门空肠吻合术后，它也可能出现门静脉高压和需要治疗的静脉曲张（VNT）。本研究旨在对BA患儿和青少年发生VNT的风险进行分层。
在这项前瞻性横断面研究中，我们通过二维剪切波弹性成像测量了53例在2018年7月至2022年9月期间前来随访的BA患者的肝脏硬度（LS）和脾脏硬度（SS），并通过内镜检查VNT情况。需要治疗的静脉曲张定义为大的食管静脉曲张、任何大小伴有红色征的食管静脉曲张和/或贲门周围的胃静脉曲张。
25例患者（年龄0 - 18岁）发生了VNT。18例患者符合Baveno VI标准（LS <20 kPa；血小板计数>150 000/L），被认为发生VNT的风险较低（无需内镜检查），而3例患者漏诊了VNT（16.7%）。应用将SS截断值设定为40 kPa并结合Baveno VI标准的Baveno VII标准，在22例无需内镜检查的患者中有5例漏诊了VNT（22.7%）。使用天冬氨酸氨基转移酶与血小板比值指数（APRI）代替血小板计数对Baveno VII标准进行修改，LS、SS和APRI的截断值分别为25 kPa、30 kPa和1.04，在20例无需内镜检查的患者中仅漏诊了1例VNT（5.0%）。
一种结合LS、SS和APRI的新型诊断标准将BA患儿和青少年漏诊VNT的风险降低至5%。
