Wu Jia-Feng, Peng Steven Shinn-Forng, Tai Chi-San, Lin Wen-Hsi, Jeng Yung-Ming, Hsu Wen-Ming, Chen Huey-Ling, Ni Yen-Hsuan, Chang Mei-Hwei
Departments of Pediatrics, National Taiwan University Hospital, No. 8, Chung-shan S. Rd., Taipei, Taiwan.
Departments of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-shan S. Rd., Taipei, Taiwan.
J Gastroenterol. 2024 Feb;59(2):138-144. doi: 10.1007/s00535-023-02051-1. Epub 2023 Oct 30.
We investigated the utilities of the liver-to-psoas apparent diffusion coefficient ratios (LTPAR) yielded by diffusion-weighted magnetic resonance imaging (DWMRI) and the age-adjusted serum matrix metalloproteinase-7 (MMP-7) for the diagnosis of biliary atresia (BA) in cholestatic infants.
In total, 170 cholestatic infants were recruited, of whom 50 (29.41%) were diagnosed with BA after cholestatic workups. The LTPAR and MMP7 levels were assessed.
The LTPAR was significantly lower in BA infants, and the age-adjusted MMP7 ratio was significantly higher, compared to other cholestatic infants (both p < 0.001). Receiver operating characteristic curve analysis yielded a cutoff > 0.1 ng/mL.day for the age-adjusted MMP-7 ratio, and an LTPAR < 1.01 for the optimal prediction of BA (both p < 0.001). Univariate logistic regression analysis revealed that both an age-adjusted MMP-7 ratio > 0.1 ng/mL.day and an LTPAR < 1.01 were significant predictors of BA among cholestatic infants (odds ratio = 30.98 and 13.28; p < 0.001 and < 0.001, respectively). The significance of the age-adjusted MMP-7 ratio and the LTPAR persisted on multivariate logistic regression analysis after adjusting for sex and the serum gamma-glutamyl transferase level (p < 0.001 and < 0.001, respectively). The negative predictive values (NPVs) for BA were 91.49% and 94.17%, respectively, for the LTPAR and age-adjusted MMP-7 ratio.
The age-adjusted MMP-7 ratio and the LTPAR are both significant non-invasive predictors of BA. The consideration of both serum and imaging parameters may enhance BA diagnostic performance in cholestatic infants.
我们研究了扩散加权磁共振成像（DWMRI）得出的肝脏与腰大肌表观扩散系数比值（LTPAR）以及年龄校正血清基质金属蛋白酶-7（MMP-7）在胆汁淤积性婴儿胆汁闭锁（BA）诊断中的效用。
共招募了170例胆汁淤积性婴儿，其中50例（29.41%）在进行胆汁淤积相关检查后被诊断为BA。评估了LTPAR和MMP7水平。
与其他胆汁淤积性婴儿相比，BA婴儿的LTPAR显著更低，年龄校正MMP7比值显著更高（均p < 0.001）。受试者操作特征曲线分析得出，年龄校正MMP-7比值的临界值> 0.1 ng/mL·天，LTPAR < 1.01时对BA的预测最佳（均p < 0.001）。单因素逻辑回归分析显示，年龄校正MMP-7比值> 0.1 ng/mL·天和LTPAR < 1.01均是胆汁淤积性婴儿BA的显著预测指标（优势比分别为30.98和13.28；p分别< 0.001和< 0.001）。在调整性别和血清γ-谷氨酰转移酶水平后，年龄校正MMP-7比值和LTPAR在多因素逻辑回归分析中仍具有显著性（分别p < 0.001和< 0.001）。LTPAR和年龄校正MMP-7比值对BA的阴性预测值分别为91.49%和94.17%。
年龄校正MMP-7比值和LTPAR均是BA重要的非侵入性预测指标。综合考虑血清和影像学参数可能会提高胆汁淤积性婴儿BA的诊断性能。
