胆道闭锁Kasai术后肝脏纤维化及生化指标变化趋势的横断面研究

目的 研究胆道闭锁患儿Kasai术后肝脏纤维化及生化指标的变化趋势.方法 采用横断面研究方法,对2013年1月至2013年12月于首都医科大学附属北京儿童医院普外科随访的胆道闭锁Kasai术后患儿进行复查资料收集,术后随访时间6个月以上,资料完整的121例纳入研究.按照Kasai术后胆红素降至正常的时间,以术后3个月、6个月为界分为优、良、差三组,获取患儿术时年龄、术前和术后Fibroscan肝脏硬度测量值及生化结果,绘制趋势图并进行统计学分析研究各组患儿Kasai术后肝脏纤维化及生化指标的变化趋势.结果 纳入本研究胆道闭锁患儿共121例,男69例(57.0％),女52例(43.0％);其中优组63例(52.1％),良组34例(28.1％),差组24例(19.8％).三组患儿术时年龄差异无统计学意义.三组患儿Fibroscan肝脏硬度测量值在术后1年内波动进展,1年后趋于稳定;单因素方差分析及秩和检验结果显示优良组差异无统计学意义,优良组与差组患儿Fibroscan肝脏硬度测量值在术后1年内差异均有统计学意义.优良组患儿总胆红素在术后前3个月下降较快,随后缓慢下降,至术后6个月稳定于正常值,而差组患儿总胆红素术后前2个月下降较快,但随后出现较大波动.三组患儿ALT趋势图均在术后1个月出现波峰,优良组术后1～6个月有所下降,但之后持续波动不能稳定,差组持续波动;三组患儿AST术后6个月内有所下降,但之后波动较大不能稳定.三组患儿CGT术后1个月达到最高峰,至术后6个月下降较快,随后逐渐趋于稳定小幅波动.结论 ①胆道闭锁患儿Kasai术后1年内肝脏纤维化波动性进展,自肝存活超过1年者肝纤维化情况进展缓慢趋于稳定,优组患儿在2年后更加稳定;②Kasai术后1个月内胆红素下降最快,3～6个月胆红素可降至正常的患儿,其胆红素水平可维持长期正常;③肝脏炎症、胆管反应、功能损害在术后仍继续进展,术后1个月开始减轻,术后6个月趋于稳定.

Cross-sectional study of liver fibrosis and biochemical trends after Kasai operation in patients with biliary atresia

Objective To explore the trends of liver fibrosis and biochemistry after Kasai operation in patients with biliary atresia (BA).Methods A cross-sectional study was performed from January 2013 to December 2013 and clinical follow-up data were collected.All 121 patients were included with postoperative time longer than 6 months.They were divided into three groups of excellent,favorable and poor according to jaundice-free duration after Kasai operation with cut-off points of 3 and 6 months.Age at Kasai operation,Fibroscan value and biochemical results before and after Kasai operation were statistically analyzed and tendency charts plotted.Results There were 69 males (57.0％) and 52 females (43.0％).Three groups were excellent 63 (52.1 ％),favorable 34 (28.1 ％) and poor 24(19.8 ％).No statistical difference in age at Kasai operation existed among three groups.The Fibroscan values of three groups fluctuated with 1 year after Kasai operation and stabilized gradually after 1 year.One-way ANOVA and rank-sum test showed statistical difference between excellent-good and poor groups within 1 year after Kasai operation.However no difference existed between excellent and good groups.Total bilirubin (TB) of excellent-good group decreased significantly in the first 3 months,declined slowly and TB became stable within a normal range.TB of poor group decreased significantly in the first 2 months with major fluctuations thereafter.Alanine transaminase (ALT) peaked at 1 month.And it decreased without stabilization within 6 months in excellent-good group.In poor group,it could not achieve stabilization.Aspartate transaminase (AST) of three groups decreased within 6 months but couldn't achieve stabilization thereafter.Gamma glutamyl transferase (GGT) of three groups peaked at 1 month,declined quickly within 6 months with minor fluctuation and became stabilized.Conclusions Liver fibrosis may progress within 1 year after Kasai operation in BA.The liver fibrosis status of survivors with native liver becomes stable and progresses slowly after 1 year.And it becomes more stable after 2 years in excellent group.TB decreases most significantly within 1 month after Kasai operation.And patients jaundice-free within 3-6 months can achieve long-term normal TB level.Liver inflammation,ductular reaction and liver function damage progress after Kasai operation.Improvement occurs after 1 month and stabilizes after 6 months.