一项前瞻性多中心研究，评估改良的简单胆道闭锁评分系统在预测胆道闭锁方面的性能。

A prospective multicentre study evaluating the performance of the modified simple biliary atresia scoring system in predicting biliary atresia.

机构信息

Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.

Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore.

出版信息

Pediatr Surg Int. 2024 Aug 27;40(1):244. doi: 10.1007/s00383-024-05830-w.

DOI:10.1007/s00383-024-05830-w

PMID:39191932

Abstract

PURPOSE

Early diagnosis of biliary atresia (BA) is critical for best outcomes, but is challenged by overlapping clinical manifestations with other causes of obstructive jaundice in neonates. We evaluate the performance of the modified Simple BA Scoring System (SBASS) in diagnosing BA.

METHODS

We performed a prospective, cross-sectional study on infants with cholestatic jaundice (June 2021-December 2022). Modified SBASS scoring was applied and compared to the eventual diagnosis (as per intraoperative cholangiogram (IOC) and liver histopathology). The score (0-6), consists of gall bladder length < 1.6 cm (+ 1), presence of triangular cord sign (+ 1), conjugated bilirubin:total bilirubin ratio > 0.7(+ 2), gamma-glutamyl transferase (GGT) ≥ 200 U/L (+ 2).

RESULTS

73 were included: Fifty-two (71%) had BA. In the non-BA group, 6 (28%) had percutaneous cholangiography (PTC) while 15 (72%) had intraoperative cholangiogram (IOC). At a cut-off of 3, the modified SBASS showed sensitivity of 96.2%, specificity of 61.9% and overall accuracy of 86.3% in diagnosing BA. Area under receiver operating characteristic curve was 0.901. GGT had the highest sensitivity (94.2%), while triangular cord sign showed the highest specificity at 95.2%.

CONCLUSION

The SBASS provides a bedside, non-invasive scoring system for exclusion of BA in infantile cholestatic jaundice and reduces the likelihood of negative surgical explorations.

摘要

目的

早期诊断胆道闭锁（BA）对于获得最佳结果至关重要，但由于新生儿阻塞性黄疸的临床表现与其他原因重叠，因此诊断具有挑战性。我们评估改良简单 BA 评分系统（SBASS）在诊断 BA 中的性能。

方法

我们对患有胆汁淤积性黄疸的婴儿进行了一项前瞻性、横断面研究（2021 年 6 月至 2022 年 12 月）。应用改良 SBASS 评分，并与最终诊断（根据术中胆管造影（IOC）和肝组织病理学）进行比较。该评分（0-6 分）包括胆囊长度<1.6cm（+1）、存在三角索征（+1）、结合胆红素/总胆红素比值>0.7（+2）、γ-谷氨酰转移酶（GGT）≥200U/L（+2）。

结果

共纳入 73 例患者：52 例（71%）为 BA。非 BA 组中，有 6 例（28%）行经皮胆管造影术（PTC），15 例（72%）行术中胆管造影术（IOC）。改良 SBASS 评分截断值为 3 分时，诊断 BA 的敏感度为 96.2%，特异度为 61.9%，总准确率为 86.3%。受试者工作特征曲线下面积为 0.901。GGT 的敏感度最高（94.2%），而三角索征的特异度最高（95.2%）。