CAJ | 학술논문

目的探讨胆道闭锁术后肝脏硬度测量值(liver stiffness measurement,LSM)的动态变化规律及LSM与血液学指标之间的关系,为评估胆道闭锁预后及序贯性治疗提供依据.方法回顾性分析2012年5月至2013年3月于我院普外科就诊的85例胆道闭锁患儿LSM和血液学指标.LSM和各项血液学指标均在同一天测得,共计224份统计资料.LSM由瞬时弹性成像仪(FibroScan)测定,血液学检查指标包括血小板(PLT)、白蛋白(ALB)、碱性磷酸酶(ALP)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、γ谷氨酰转肽酶(GGT)、总胆红素(TBIL)、总胆汁酸(TBA).把所收集到的224份统计资料按照接受检查的时间顺序分成12组.结果 LSM与ALP、AST、GGT、TBIL、TBA呈正相关(r分别为0.391、0.171、0.243、0.194、0.327,P值均＜0.01),与PLT、ALB呈负相关(r分别为0.267、0.249,P值均＜0.01).胆道闭锁术后LSM先上升,至术后3个月达到峰值,后逐渐下降至术后1年6个月,然后维持这一水平上下波动.术后血清ALT变化趋势与LSM基本一致.术后3个月血清TBIL和LSM均出现一个峰值.术后3个月LSM与其他各组LSM的差异均有统计学意义(P＜0.01).224份统计资料中,LSM的最大值为75.0 kPa,共出现5次,有4次出现在术后3个月,这4例患儿中的2例因胆管炎和/或顽固性腹水分别于术后6个月和8个月死亡.结论胆道闭锁术后LSM呈动态变化,LSM与肝细胞的损伤情况及肝纤维化密切相关,血清ALT和TBIL水平可能影响LSM评价肝纤维化的准确性,胆道闭锁术后3个月LSM最高,术后3个月较高的LSM可能预示着较差的预后.
목적 탐토담도폐쇄술후간장경도측량치(liver stiffness measurement,LSM)적동태변화규률급LSM여혈액학지표지간적관계,위평고담도폐쇄예후급서관성치료제공의거.방법 회고성분석2012년5월지2013년3월우아원보외과취진적85례담도폐쇄환인LSM화혈액학지표.LSM화각항혈액학지표균재동일천측득,공계224빈통계자료.LSM유순시탄성성상의(FibroScan)측정,혈액학검사지표포괄혈소판(PLT)、백단백(ALB)、감성린산매(ALP)、곡초전안매(AST)、곡병전안매(ALT)、γ곡안선전태매(GGT)、총담홍소(TBIL)、총담즙산(TBA).파소수집도적224빈통계자료안조접수검사적시간순서분성12조.결과 LSM여ALP、AST、GGT、TBIL、TBA정정상관(r분별위0.391、0.171、0.243、0.194、0.327,P치균＜0.01),여PLT、ALB정부상관(r분별위0.267、0.249,P치균＜0.01).담도폐쇄술후LSM선상승,지술후3개월체도봉치,후축점하강지술후1년6개월,연후유지저일수평상하파동.술후혈청ALT변화추세여LSM기본일치.술후3개월혈청TBIL화LSM균출현일개봉치.술후3개월LSM여기타각조LSM적차이균유통계학의의(P＜0.01).224빈통계자료중,LSM적최대치위75.0 kPa,공출현5차,유4차출현재술후3개월,저4례환인중적2례인담관염화/혹완고성복수분별우술후6개월화8개월사망.결론 담도폐쇄술후LSM정동태변화,LSM여간세포적손상정황급간섬유화밀절상관,혈청ALT화TBIL수평가능영향LSM평개간섬유화적준학성,담도폐쇄술후3개월LSM최고,술후3개월교고적LSM가능예시착교차적예후.
Objective To explore the dynamic changes of liver stiffness measurement (LSM) in postoperative biliary atresia (BA) and examine the relationship between LSM and hematological indicators so as to provide rationales for prognostic assessment and sequential treatment of BA,Methods A retrospective analysis was conducted for LSM and hematological indicators of 85 BA patients from May 2012 to March 2013.LSM and hematological indicators were measured on the same day with 224 statistics available.And liver stiffness was evaluated by transient elastography (FibroScan).The hematological indicators included platelet (PLT),albumin (ALB),alkaline phosphatase (ALP),alanine aminotransferase (ALT),aspartate aminotransferase (AST),y glutamyltranspeptidase (GGT),total bilirubin (TBIL) and total bile acid (TBA).According to the time sequence of inspection,224 statistics were divided into 12 groups.Results LSM was positively correlated with ALP,AST,GGT,TBIL and TBA (r =0.391,0.171,0.243,0.194,0.327 respectively,all P＜0.01) and negatively correlated with PLT and ALB (r =0.267,0.249 respectively,both P＜0.01).In postoperative BA,LSM rose initially,peaked within 3 months and gradually decreased until 18 months.Then it stabilized at this level.The serum changes of postoperative ALT and LSM were basically identical.Both TBIL and LSM peaked within 3 months.LSM within 3 months was different from the other groups (all P＜0.01).Among 224 statistics,4 out of 5 LSM maximum at 75.0 kPa appeared within 3 months.And 2 children died from cholangitis and/ or refractory ascites at 6 and 8 months respectively.Conclusions In postoperative BA,LSM undergoes dynamic changes and it is closely correlated with hepatocytic damage and hepatic fibrosis.The serum levels of ALT and TBIL may affect the accuracy of LSM evaluation for liver fibrosis.LSM peaks at 3 months and a higher LSM at that time may portend a poor prognosis.