高频彩色多普勒超声在诊断小儿胆道闭锁中的应用

目的分析儿童胆道闭锁中的超声图像特征,探讨高频彩色多普勒超声在早期诊断胆道闭锁中的应用价值。方法回顾性分析46例经手术及病理确诊的胆道闭锁患儿术前超声图像资料,结合术中病理结果,分析高频彩色多普勒超声时提示肝脏大小及内回声情况,胆囊显示率及胆囊大小、形态,肝门区结构,肝动脉内径及血流频谱特征的作用,评估其早期诊断价值。结果术前超声提示肝脏形态增大,肝内回声改变24例(52%),胆囊长径15mm 20例,胆囊长径15mm 18例,胆囊未显示2例,胆囊显示欠清(考虑裂隙样胆囊)6例。超声提示肝门部纤维块42例,2例MRI提示胆道闭锁,2例超声提示肝门部小囊腔。肝动脉内径2.2~2.8mm,均值2.4mm。肝动脉频谱为高速高阻血流,PSV:77~123cm/s,RI:0.89~0.96。结论胆囊形态及肝门部纤维块是超声诊断胆道闭锁的重要征象,综合分析肝脏形态及肝动脉内径与频谱特征对早期诊断小儿胆道闭锁具有一定价值。     

胆道闭锁与婴儿肝炎综合征的诊断和鉴别指标的分析

目的 回顾性分析梗阻性黄疸患儿的实验室指标、肝胆超声与磁共振胰胆管造影在胆道闭锁与婴儿肝炎综合征的诊断及鉴别诊断中的应用价值.方法 收集2010年1月至2012年12月间在我院住院治疗的梗阻性黄疸患儿70例,胆道闭锁患儿50例,婴儿肝炎综合征患儿20例,均行肝胆超声及磁共振胰胆管造影检查;比较两者敏感度、特异性、准确性及预测值等,并对实验室相关指标进行统计分析及组间比较.结果 胆道闭锁组和婴儿肝炎综合征组谷氨酰转肽酶分别为(743.5±564.0) IU/L、(198.8±197.8)IU/L,差异有统计学意义(P＜0.05).若以谷氨酰转肽酶＞300IU/L作为胆道闭锁诊断标准,谷氨酰转肽酶诊断胆道闭锁灵敏度、特异性、准确性分别为89.58％、68.18％、82.85％).肝胆超声诊断胆道闭锁灵敏度、特异性、准确性分别为84.0％、100.0％、88.6％;磁共振胰胆管造影检查诊断胆道闭锁灵敏度、特异性、准确性分别为82.0％、80.0％、81.4％;差异均有统计学意义(P＜0.05).结论 目前,肝胆超声是诊断胆道闭锁并与鉴别婴儿肝炎综合征的可靠方法,其敏感度、特异度、准确性、阳性预测价值、阴性预测价值均高于磁共振胰胆管造影检查.     

抗环瓜氨酸肽抗体和隐匿性类风湿因子免疫球蛋白M型在诊断早期幼年类风湿关节炎中的意义

目的 检测抗环瓜氨酸肽(CCP)抗体及隐匿性类风湿因子IgM型(HRF-IgM),并探讨其在幼年类风湿关节炎(JRA)早期诊断中的临床意义。方法 用人工合成CCP链为抗原检测抗CCP抗体;对27例早期诊断的JRA做动态检测,通过阳性预测值(PPV)和阴性预测值(NPV)确定抗CCP抗体和HRF-IgM对早期诊断的JRA的特异性和敏感性。结果 抗CCP抗体和HRF-IgM总阳性率分别为58.5％、65.0％。后者敏感性要高于前者,病情越重或受累的关节越多,抗体检出率越高。对早期JRA的PPV、抗CCP抗体特异性要高于HRF-IgM。当两种实验联合应用时,对具有早期关节炎表现发展成JRA的PPV为93.7％。结论 抗CCP抗体和HRF-IgM在JRA患儿均有较高的检出率,并与疾病严重程度有关。抗CCP抗体与HRF-IgM联合应用时,可使JRA的PPV进一步提高。     

婴儿胆道闭锁超声诊断价值

目的 回顾总结近年来经手术证实的胆道闭锁患儿超声表现,归纳其声像图特征并与文献比较.方法 临床黄疸的婴儿禁奶4 ～ 6 h,对肝、胆、胰、脾、肾及腹腔进行超声检查,46例超声检查怀疑胆道闭锁患儿中15例进行手术并证实胆道闭锁.结果 15例胆道闭锁患儿的胆囊均表现异常,其中未发现胆囊者4例,其余胆囊呈一裂隙样表现,长度＜ 1.6 cm,或呈索条样,13例胆总管未探及.门静脉和(或)门静脉左支前方不规则或索条样回声增强8例,肝动脉扩张8例.结论 超声检查作为一种无创便捷的检查方法对胆道闭锁的诊断准确性较高,成为婴儿黄疸鉴别诊断的常规手段.     

超声检查在胆道闭锁鉴别诊断中的运用价值

目的 探讨超声检查胆囊大小、形态及肝门区结构在早期鉴别诊断胆道闭锁和婴儿肝炎综合征方面的运用价值。方法回顾2002～2006年204例拟诊为阻塞性黄疸的婴儿的超声检查资料，并与手术造影、临床诊断相比较，统计胆囊显示率、胆囊大小及其在胆道闭锁和婴儿肝炎综合征之间的差异；回顾2002～2006年的超声图像，综合分析胆囊充盈情况、形态及肝门区结构，评估其诊断价值。结果204例中，182例经手术探查及造影确诊，其中胆道闭锁（BA）151例（83％），婴儿肝炎综合征（IHS）29例（16％），先天性胆道发育不良2例（1％）。超声探及胆囊的BA患儿97例（占BA患儿的64.24％），探及胆囊的IHS患儿24例（古IHS患儿的82．76％），BA患儿胆囊显示率明显低于IHS患儿（P〈0．05）。BA患儿胆囊长度均值为1．28cm，体积均值为0．27ml；IHS患儿胆囊长度均值为2．03cm，体积均值为0．61ml，两组差异有统计学意义（P〈0．05）。回顾性分析胆囊、肝门区结构，诊断灵敏度为99．34％，特异度为83．87％，符合率为96．7％。结论超声检查综合分析胆囊大小、形态及肝门区结构在早期鉴别诊断胆道闭锁和婴儿肝炎综合征方面有一定的运用价值。     

胆道闭锁疑似病例的临床特征和诊断依据分析

目的 回顾手术确诊非胆道闭锁和胆道闭锁两组病例的临床资料,分析胆道闭锁疑似病例的临床特征和术前疑诊为胆道闭锁的原因.方法 收集2004年至2010年本院术前拟诊为胆道闭锁而行腹腔镜或开腹胆道造影的602例患儿的临床资料,依据术中胆道造影的诊断结果分为非胆道闭锁组和胆道闭锁组.分析近年非胆道闭锁病例所占比例,对照两组患儿黄疸发生日龄、肝功能及B型超声结果.计算同位素肝胆排泄性造影诊断胆道闭锁的阳性预测值及假阳性率,以及非胆道闭锁病例的疾病构成.结果 非胆道闭锁组83例,胆道闭锁组519例.近年行手术探查的所有患儿中非胆道闭锁比例无明显下降.两组出现黄疸的日龄、入院TBIL(169.9 mmol/L比172.3 mmol/L,P＞0.05)、DBIL(128.7 mmol/L比132.5 mmol/L,P＞0.05)、DBIL/TBIL(0.76比0.77,P＞0.05)、ALT(141.3 mmol/L比114.9 mmol/L,P＞0.05)比较均无统计学差异.γ-GT非胆道闭锁组显著低于胆道闭锁组(263.2 mmol/L比902.7 mmol/L,P＜0.01),B型超声检查肝脏肋下大小,非胆道闭锁组小于胆道闭锁组(2.99比3.61,P＜0.01).同位素肝胆排泄性造影阳性患儿共498例,其中术后诊断为非胆道闭锁患儿66例,假阳性率为13.3％.83例非胆道闭锁组包括:婴儿肝炎综合征58例,胆道发育不良16例,TPN相关性胆汁淤积症5例,胆道穿孔和浓缩胆栓综合征各2例.结论 肝功能检查的相似性及过度依赖同位素肝胆排泄性造影可能是非胆道闭锁患儿疑诊为胆道闭锁的主要原因,术前仔细分析黄疸出现的日龄、γ-GT、B型超声检查肝脏大小有利于非胆道闭锁病例术前的鉴别诊断.     

产前诊断胆道闭锁影像学研究

目的：胆道闭锁早期诊断困难,而产前诊断更是极少发现。本文对产前诊断的胆道闭锁影像学特点进行探讨。方法回顾我院2010年至2012年收治的产前诊断9例产前诊断胆道畸形患儿,入院手术年龄24 d至2岁。全部患儿行腹腔镜胆道造影,4例诊断胆道闭锁,5例诊断先天性胆管扩张症,胆道闭锁患儿中2例接受腹腔镜下肝管空肠ROUX-Y吻合术,2例接受开腹肝门空肠吻合术。观察其临床表现,超声和实验室指标,术中情况,术后恢复情况等。结果4例患儿产前超声未见胆囊或胆囊显示不清。产前超声发现肝门部囊肿的3例患儿,囊肿小且均无明显增大,张力较高,呈规则圆形。产前诊断发现肝门囊肿的3例患儿术中证实为胆总管远端闭锁（Ⅰ型胆道闭锁）,未发现胆囊也未发现囊肿的1例患儿证实为Ⅲ型胆道闭锁。生后全部胆道闭锁患儿出现黄疸,最早出现在生后第2天,但都未出现陶土样便。全部胆道闭锁患儿囊肿大小形态无明显变化。全部患儿查ALT、AST、rGGT、直接胆红素和总胆红素进行性升高。2例接受腹腔镜下肝管空肠ROUX-Y吻合术,2例接受开腹肝门空肠吻合术。全部4例患儿术后恢复好。结论产前超声检查可以确定胆道闭锁,如果发现肝门部囊肿的胎儿,应定期接受超声检查,如果囊肿在孕期变化不明显,应怀疑囊肿型胆道闭锁。如产前超声未发现胆囊结构,则应怀疑为Ⅲ型胆道闭锁。生后应密切观察、超声、生化、黄疸情况。如果黄疸进行性加重可及早进行腹腔镜胆道造影及手术治疗。     

彩色多普勒超声诊断小儿急性阑尾炎的临床应用研究

目的探讨彩色多普勒超声诊断小儿急性阑尾炎的临床应用。方法对临床拟诊的78例急性阑尾炎的患儿全部行彩色多普勒超声检查以明确诊断及鉴别诊断。结果78例临床拟诊的急性阑尾炎病人，经彩色多普勒超声检查诊断为急性阑尾炎的51例，全部行手术治疗，经手术及术后病理检查50例证实为急性阑尾炎。本组出现假阳性1例，假阴性1例，准确率为97．7％。结论采用无创伤性、简单安全的彩色多普勒超声诊断小儿急性阑尾炎可靠、准确，值得推广应用。     

彩色多普勒超声对胃食管反流的筛检价值

目的　探讨彩色多普勒超声对胃食管反流 (GER)的筛检价值。方法　用彩色多普勒超声以肝左叶为透声窗 ,经剑突下扫查胃食管反流患儿、正常对照儿童各 55例。分别测量与观察腹段食管长度、GER现象及反流发生频率。结果　腹段食管清晰显示率 1 0 0 % ;正常对照组小儿腹段食管长度随年龄增加而增长 ;病例组与之比较显示腹段食管长度缩短。彩超检查GER的灵敏性为 98.1 8% ;特异性为 76 .36 %。结论　彩色多普勒超声可以清晰显示腹段食管 ;胃食管反流患儿腹段食管长度缩短 ;彩色多普勒超声可作为胃食管反流的筛检手段。     

小儿感染性心内膜炎两种诊断标准诊断价值的比较

目的比较国内制订的小儿感染性心内膜炎(infective endocarditis, IE)的诊断标准(简称试行标准)与Duke标准的诊断结果和诊断价值.方法 33例临床诊断为IE的患儿,29例行手术治疗;4例具有尸检资料;用惠普超声心动图仪探查其心脏内赘生物.以手术、病理或尸检资料为金标准,按Duke标准和试行标准分别进行诊断分组,其诊断结果分为"确诊"、"可疑"和"排除".结果 23例经手术、病理或尸检证实为IE,10例排除IE.Duke标准和试行标准的特异性和阳性预测值均为100%,但Duke标准的敏感性和准确性分别为65.2%和75.8%,而试行标准分别为91.3%和93.9%.对于血培养阳性者两种标准的敏感性和特异性均为100%;对于血培养阴性患者虽然特异性和阳性预测值均为100%,但Duke标准的敏感性和准确性分别为11.1%和57.9%,而试行标准分别为77.7%和89.5%.对于33例临床诊断为IE者,两种标准的Youden指数差异无显著性(P＞0.05),但对于19例血培养阴性患儿,两种标准的Youden指数差异有显著性(P＜0.01).结论试行标准和Duke标准具有相同的特异性和阳性预测值,但前者敏感性和准确性较高.     

Evaluation of Diagnostic Value of Procalcitonin as a Marker of Neonatal Bacterial Infections

Objective

This study tried to assess sensitivity, specificity, positive and negative predictive value of procalcitonin for diagnosis of neonatal bacterial infections.

Methods

This prospective cross sectional study was carried out during an 18-month period in NICU and neonatal wards of Besat Hospital in Hamedan province, Iran. 39 symptomatic infants with clinical and laboratory findings in favor of bacterial infection with a positive blood, CSF, and/or supra pubic urine culture entered the study; 32 newborns without any bacterial infection served as control group. Quantitative procalcitonin level ≥0.5 ng/ml was accepted as pathological. Finally sensitivity, specificity, positive (PPV) and negative predictive value (NPV) were calculated for procalcitonin test.

Findings

20 blood cultures, 17 urine cultures and 8 CSF cultures were positive. Sensitivity, specificity, PPV and NPV for procalcitonin test was 76.9%, 100%, 100% and 78% respectively. Diagnostic value of procalcitonin test in accordance with blood culture for mentioned items was 85%, 100%, 100% and 91.4% respectively. Its diagnostic value according to urine culture was: sensitivity 70.6%, specificity 100%, PPV 100% and NPV 86.4%, and according to CSF culture was: sensitivity 75%, specificity 100%, PPV 100% and NPV 94.1% respectively.

Conclusion

The results show that the procalcitonin test has high sensitivity, specificity, PPV and NPV for diagnosis of neonatal infections.     

超声筛检肥胖儿童脂肪肝的价值评估

目的 评价常规超声在筛检肥胖儿童脂肪肝中的灵敏度和特异度。方法 162 例肥胖儿童（年龄 10.5±2.2 岁,体重指数 28±4）纳入该研究,均进行肝脏超声和磁共振氢谱（1H MRS）检查。1H MRS 直接检测到的肝脏脂肪信号百分数通过相应的校准程序换算成甘油三酯重量百分数（mg/g 湿重）,表示肝脏脂肪含量（LFC）。以1H MRS 结果为参考标准,计算超声筛检肥胖儿童脂肪肝的灵敏度、特异度、阳性预测值和阴性预测值。结果 根据 LFC>5% 的量化诊断标准,1H MRS 确定 58.6%（95/162）的肥胖儿童患有脂肪肝,超声筛检脂肪肝的灵敏度为 91.6%（87/95）,特异度为 50.7%（34/67）,阳性预测值为 72.5%（87/120）,阴性预测值为 81.0%（34/42）。不同超声等级的脂肪肝分组与 LFC 四分位数分组间存在明显的交互重叠。结论 常规超声筛检肥胖儿童脂肪肝的灵敏度高,而特异度较低,提示常规超声可应用于肥胖儿童的脂肪肝筛检,必要时进行1H MRS 检查加以明确。     

超声剪切波弹性成像联合血液生化指标对胆道闭锁的诊断价值

目的 探讨超声剪切波弹性成像联合血液生化指标对胆道闭锁(biliary atresia,BA)的诊断价值.方法 对湖南省儿童医院临床拟诊为胆汁淤积性肝病的患者行常规超声检查及肝脏剪切波弹性成像(shear wave elastography,SWE)检查,同时收集距SWE检查近3天内肝功能血生化指标.经术中胆管造影及肝...     

基于超声、肝胆核素显像和磁共振胆胰管成像影像学检查诊断胆道闭锁准确性研究的系统评价和Meta分析

目的明确影像学检查［超声、肝胆核素显像和磁共振胆胰管成像（MRCP）］在胆道闭锁诊断中的价值。方法根据“biliary atresia,bile duct atresia”和“胆道闭锁,胆管闭锁”建立的检索式检索英文Pubmed、Embase、Medline数据库（起于建库）和中文CBM数据库（起于2000年1月1日）,止于2020年4月26日,按胆道闭锁临床实践指南的纳入、排除标准筛选文献,并使用QUADAS-2量表对纳入文献偏倚风险及临床适用性进行评价。提取文献数据,计算诊断参数。结果30篇超声文献进入Meta分析：肝门三角征（24篇文献）,敏感度79%（95%CI：68%~86%）,特异度97%（95%CI：94%~98%）,I2＞97%,诊断比值比（DOR）=103（95%CI：52~203）,SROC曲线提示曲线下面积（AUC）为0.97（95%CI：0.95~098）,Deeks检测P=0.28,发表偏倚的可能较小;胆囊形态、胆囊大小、胆总管有无和肝动脉直径各有9、12、5和6篇文献,敏感度分别为73%、78%、92%和83%,特异度分别为94%、76%、76%和78%,I2均＞70%,DOR分别为42、11、12和17,SROC曲线提示AUC分别为0.94、0.81、0.92和0.87。32篇肝胆核素显像文献进入Meta分析,敏感度98%(95%CI：95%~99%),特异度75%（95%CI：69%~81%）,I2＞75%,DOR=140（95%CI：50~392）,SROC曲线提示AUC为0.93（95%CI：0.91~0.95）,Deeks检测P=0.05,发表偏倚的可能较小;按检查前口服肝酶诱导剂（苯巴比妥）、使用99m锝造影剂、肠道内显影和肠道或胆囊显影行亚组分析,各有18、28、18和11篇文献进入Meta分析,敏感度97%~99%,特异度75%~78%,I2均＞75%,DOR分别为239、251、246和109。7篇MRCP文献进入Meta分析,敏感度92%(95%CI：79%~97%),特异度82%（95%CI：63%~92%）,I2为75%和83%,DOR=52（95%CI：7~382）,SROC曲线提示AUC为0.94（95%CI：0.91~0.96）。结论超声探测到肝门三角征较其他超声特征（胆囊形态、肝动脉直径、胆总管有无和胆囊大小）对诊断胆道闭锁有明确的优势;无论是检查前口服肝酶诱导剂、采用99m锝造影剂、肠道内显影或胆囊显影, 肝胆核素显像对胆道闭锁误诊率仍很高;MRCP对诊断胆道闭锁的结果不稳健。     

The value of nasopharyngeal culture in predicting the etiology of acute otitis media in children less than two years of age

BACKGROUND: In selecting treatment of acute otitis media (AOM), knowledge of its etiology would be valuable. We revisited the possibility to use the nasopharyngeal culture of Streptococcus pneumoniae (Pnc) and Haemophilus influenzae (Hi) for predicting their presence in the middle ear fluid (MEF) during AOM. METHODS: The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of bacterial culture of the nasopharyngeal aspirate (NPA) in predicting the presence of the same pathogen in the MEF were assessed during AOM events among children followed from 2 to 24 months of age. RESULTS: The data comprised 586 AOM events. For Pnc, the sensitivity and NPV were high, 99% (95% confidence interval = 95-100%) and >99% (97-100%), respectively. The specificity and PPV were relatively low, 63% (57-68%) and 50% (43-56%). For Hi, the sensitivity and the NPV were lower (77%, 69-83% and 93%, 90-95%) than for Pnc, but the specificity and the PPV were higher (88%, 85-91% and 64%, 56-71%). The quantity of Pnc and Hi in the NPA was clearly related to their presence in the MEF. If both Pnc and Hi were found in the nasopharynx, Hi was more likely cultured from MEF. CONCLUSION: Together with clinical and epidemiologic features of AOM, the nasopharyngeal culture can be helpful in selecting specific antimicrobial therapy.     

Diagnostic Value of Procalcitonin and Apo-E in Extrahepatic Biliary Atresia

Objective: Extrahepatic biliary atresia (EHBA) is one of the main causes of neonatal cholestasis. Its early diagnosis could increase the survival of the infants with early surgery. We evaluated the diagnostic accuracy of procalcitonin and apolipoprotein E (Apo-E) levels in infants with and without EHBA. Methods: This prospective study included 18 infants with EHBA and 15 infants with other causes of cholestasis. Blood samples were taken from each patient and different markers including procalcitonin and Apo-E levels were measured. ROC analysis was used to define sensitivity, specificity, positive and negative predictive value (PPV and NPV) for procalcitonin and Apo-E. Findings : There was a significantly positive correlation between Apo-E and SGOT (r=0.37, P=0.03), SGPT (r=0.38, P=0.02) and GGT (r=0.38, P=0.02), and an inverse correlation between procalcitonin and GGT (r=-0.45, P=0.01). Area under curve (AUC) for procalcitonin was 0.69 (P=0.05) with cut-point of 0.735 ng/ml. The sensitivity, specificity, PPV and NPV was 67%, 61%, 69% and 59%, respectively. AUC for Apo-E was 0.68 (P=0.06) for cut-point of 61.25 ng/ml with sensitivity, specificity, PPV and NPV of 67%, 67%, 71% and 67%, respectively. Conclusion: Both PCT and Apo-E have relatively good accuracy in diagnosing EHBA cases; we could not rely on these markers for diagnosis of EHBA, however, combinations of these biomarkers with other markers and imaging tests could improve their accuracy and may help to achieve a rapid and accurate diagnosis of EHBA.Key Words: Neonatal Cholestasis, Extrahepatic Biliary Atresia, Procalcitonin, Apolipoprotein E     

Celiac disease in Turkish short-statured children and the value of antigliadin antibody in diagnosis

Abstract Background. It is generally accepted that celiac disease (CD) must always be taken into consideration when dealing with children manifesting growth failure. It is, therefore, important to have laboratory tests capable of detecting patients who should undergo intestinal biopsy. In this study, we have prospectively evaluated clinical characteristics, gliadin antibody measurements and duodenal biopsies in 47 children with short stature and without gastrointestinal symptoms, in order to determine the incidence of CD and the diagnostic value of immunoglobulin (Ig)A and IgG antigliadin antibodies (AGA) for CD.
Methods: Anthropometric parameters and IgA- and IgG AGA were evaluated in 47 children with short stature. Antigliadin antibodies were measured by enzyme-linked immunosorbent assay (Euroimmun kit). Endoscopic intestinal biopsies were taken from all children.
Results: On the basis of intestinal biopsy, 26 (55.3%) patients were found to be probable CD. Sensitivity, specificity, positive predictive (PPV) and negative predictive value (NPV) for IgA AGA was found to be 23, 90, 75 and 48%, respectively. Sensitivity, specificity and PPV for IgG AGA was 100, 0 and 55%, respectively. The NPV for IgG AGA was not determined.
Conclusions: The results of our study demonstrated that because of their incomplete sensitivity, specificity, PPV and NPV, intestinal biopsy can not be replaced by these tests.     

13 C-尿素呼气试验诊断小儿幽门螺杆菌感染的研究

目的 评估＾１３Ｃ尿素呼气试验检测小儿幽门螺杆菌（ＨＰ）感染的可靠性。方法 ３７例具有上消化道症状的患儿行内镜检查,胃窦部粘膜活检,经快速尿素酶试验,组织学或ＨＰ培养,以决定是否感染,ＨＰ,并作＾１３Ｃ－尿素呼气试验。＾１３Ｃ－尿素呼气试验的敏感性、特异性、阳性预计值、阴性预计值是与内镜检测Ｈ的结果比较计算得到的。结果 ＾１３Ｃ－尿素呼气试验的敏感性为１００％,特异性为９６％,阳性预测值９３％,阳     

胆道闭锁术后早期胆管炎风险因素分析

目的 探讨影响胆道闭锁术后早期胆管炎发作的风险因素. 方法 对本院2007年1月至2011年12月收治胆道闭锁患儿临床资料进行回顾性分析.所有患儿均采用统一治疗方案,包括手术方式为标准Kasai手术或肝管空肠吻合术,术中胆支引流肠襻45 cm,术后使用激素、抗菌素和利胆药物.将病例以手术年龄、术后黄疸清除效果、Ohi分型和肝纤维化病理分级进行分组,分析影响早期胆管炎发作的原因. 结果 共有139例BA患儿进行手术,124例获得随访.术后35例早期胆管炎发作,发生率为28.3％.术后黄疸完全清除率早期胆管炎发作组低于未发作组（28.2％∶71.8％,P=0.004）,术后1年、2年自体肝生存率早期胆管炎发作组低于未发作组（分别为44.5％±8.5％∶86.5％±3.6％,44.5％±8.5％∶76.3％±4.5％,P=0.003）.Logistic分析显示黄疸清除速度（P=0.000）,肝纤维化病理分级（P =0.029）和Ohi分型基本型（P =0.042）影响早期胆管炎发作而与手术年龄（P=0.579）,Ohi分型亚型（P=0.511）和肝外胆管详细分型（P =0.224）无关.结论 良好的肝门部病变类型,术后较好的胆汁引流和较轻的肝纤维化有利于减少胆道闭锁术后早期胆管炎的发生.     

Validation of Neurologic Impairment Diagnosis Codes as Signifying Documented Functional Impairment in Hospitalized Children

ObjectiveTo assess the performance of previously published high-intensity neurologic impairment (NI) diagnosis codes in identification of hospitalized children with clinical NI.MethodsRetrospective study of 500 randomly selected discharges in 2019 from a freestanding children's hospital. All charts were reviewed for 1) NI discharge diagnosis codes and 2) documentation of clinical NI (a neurologic diagnosis and indication of functional impairment like medical technology). Test statistics of clinical NI were calculated for discharges with and without an NI diagnosis code. A sensitivity analysis varied the threshold for “substantial functional impairment.” Secondary analyses evaluated misclassified discharges and a more stringent definition for NI.ResultsDiagnosis codes identified clinically documented NI with 88.1% (95% confidence interval [CI]: 84.7, 91) specificity, and 79.4% (95% CI: 67.3, 88.5) sensitivity; negative predictive value (NPV) was 96.7% (95% CI: 94.8, 98.0), and positive predictive value (PPV) was 49% (95% CI: 42, 56.1). Including children with milder functional impairment (lower threshold) resulted in NPV of 95.7% and PPV of 77.5%. Restricting to children with more severe functional impairment (higher threshold) resulted in NPV of 98.2% and PPV of 44.1%. Misclassification was primarily due to inclusion of children without functional impairments. A more stringent NI definition including diagnosis codes for NI and feeding tubes had a specificity of 98.4% (95% CI: 96.7–99.3) and sensitivity of 28.6% (19.4–41.3).ConclusionsAll scenarios evaluated demonstrated high NPV and low-to-moderate PPV of the diagnostic code list. To maximize clinical utility, NI diagnosis codes should be used with strategies to mitigate the risk of misclassification.