Brits Elizabeth, Brown Stephen, Botes Lezelle, Sempa Joseph B, Pienaar Michael
Division of Paediatric Surgery, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
Division of Paediatric Cardiology, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
J Pediatr Surg. 2025 Apr;60(4):162234. doi: 10.1016/j.jpedsurg.2025.162234. Epub 2025 Feb 1.
Biliary atresia (BA) is a severe paediatric liver disease causing cirrhosis without prompt treatment. Aspartate aminotransferase-to-platelet ratio index (APRi), a non-invasive biomarker, shows promise in assessing fibrosis and cirrhosis severity, offering an alternative to liver biopsy. However, standardised criteria and research on APRi accuracy in paediatric BA, especially across diverse populations, remain limited.
To assess the correlation between APRi values, liver fibrosis and cirrhosis severity in children with BA, evaluate APRi's diagnostic accuracy and clinical utility, and identify appropriate cut-off values for significant fibrosis and cirrhosis.
This systematic review and meta-analysis, conducted per PRISMA guidelines, evaluated non-invasive biomarkers for liver fibrosis in BA patients. Data were managed using REDCap and analysed with R software. Heterogeneity was assessed with the Cochrane Q test and I values.
Fourteen studies (retrospective, prospective, and one cross-sectional) examined APRi and liver fibrosis in BA. APRi cut-off values for diagnosing fibrosis and cirrhosis ranged from 0.7 to 2.26 for advanced fibrosis (F3). The meta-analysis provided pooled means and 95% confidence intervals for APRi, assessing its diagnostic performance. Significant heterogeneity was noted in studies with favourable histology, while none was observed in those with unfavourable histology, highlighting variability in APRi values.
Limited patient numbers and significant heterogeneity across studies impeded the establishment of a definitive threshold for identifying unfavourable histology in BA. Consequently, APRi's clinical utility remains unclear. Further research is required to determine its precise role as a biopsy surrogate and in clinical decision-making during BA diagnosis.
Study of diagnostic test.
IV.
胆道闭锁（BA）是一种严重的儿科肝脏疾病，若不及时治疗会导致肝硬化。天冬氨酸转氨酶与血小板比值指数（APRi）作为一种非侵入性生物标志物，在评估肝纤维化和肝硬化严重程度方面显示出前景，为肝活检提供了一种替代方法。然而，关于儿科BA中APRi准确性的标准化标准和研究，尤其是在不同人群中的研究，仍然有限。
评估BA患儿中APRi值与肝纤维化和肝硬化严重程度之间的相关性，评估APRi的诊断准确性和临床实用性，并确定显著纤维化和肝硬化的合适临界值。
本系统评价和荟萃分析按照PRISMA指南进行，评估BA患者肝纤维化的非侵入性生物标志物。数据使用REDCap进行管理，并使用R软件进行分析。采用Cochrane Q检验和I值评估异质性。
14项研究（回顾性、前瞻性和1项横断面研究）对BA中的APRi和肝纤维化进行了研究。诊断晚期纤维化（F3）的APRi临界值范围为0.7至2.26。荟萃分析提供了APRi的合并均值和95%置信区间，评估其诊断性能。在组织学良好的研究中观察到显著异质性，而在组织学不良的研究中未观察到，这突出了APRi值的变异性。
研究中患者数量有限以及显著的异质性阻碍了确定BA中不良组织学的明确阈值。因此，APRi的临床实用性仍不明确。需要进一步研究以确定其作为活检替代指标的确切作用以及在BA诊断中的临床决策作用。
诊断试验研究。
IV。
