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Han YJ, Hu SQ, Zhu JH, Cai X, Lai DM, Chen BH, Zhu K, Tong Q, Zhou XR, Deng JL, Tou JF, Fang Z, Du LZ. Accurate prediction of biliary atresia with an integrated model using MMP-7 levels and bile acids. World J Pediatr 2024; 20:822-833. [PMID: 38141111 PMCID: PMC11402860 DOI: 10.1007/s12519-023-00779-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/05/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Biliary atresia (BA) is a rare fatal liver disease in children, and the aim of this study was to develop a method to diagnose BA early. METHODS We determined serum levels of matrix metalloproteinase-7 (MMP-7), the results of 13 liver tests, and the levels of 20 bile acids, and integrated computational models were constructed to diagnose BA. RESULTS Our findings demonstrated that MMP-7 expression levels, as well as the results of four liver tests and levels of ten bile acids, were significantly different between 86 BA and 59 non-BA patients (P < 0.05). The computational prediction model revealed that MMP-7 levels alone had a higher predictive accuracy [area under the receiver operating characteristic curve (AUC) = 0.966, 95% confidence interval (CI): 0.942, 0.989] than liver test results and bile acid levels. The AUC was 0.890 (95% CI 0.837, 0.943) for liver test results and 0.825 (95% CI 0.758, 0.892) for bile acid levels. Furthermore, bile levels had a higher contribution to enhancing the predictive accuracy of MMP-7 levels (AUC = 0.976, 95% CI 0.953, 1.000) than liver test results. The AUC was 0.983 (95% CI 0.962, 1.000) for MMP-7 levels combined with liver test results and bile acid levels. In addition, we found that MMP-7 levels were highly correlated with gamma-glutamyl transferase levels and the liver fibrosis score. CONCLUSION The innovative integrated models based on a large number of indicators provide a noninvasive and cost-effective approach for accurately diagnosing BA in children. Video Abstract (MP4 142103 KB).
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Affiliation(s)
- Yi-Jiang Han
- Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Shu-Qi Hu
- Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jin-Hang Zhu
- Department of Data and Analytics, WuXi Diagnostics Innovation Research Institute, Shanghai, China
| | - Xiao Cai
- Department of Data and Analytics, WuXi Diagnostics Innovation Research Institute, Shanghai, China
| | - Deng-Ming Lai
- Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Bao-Hai Chen
- Department of Information Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Kun Zhu
- Department of Pathology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qiao Tong
- Department of Data and Analytics, WuXi Diagnostics Innovation Research Institute, Shanghai, China
| | - Xin-Rui Zhou
- Department of Data and Analytics, WuXi Diagnostics Innovation Research Institute, Shanghai, China
| | - Jia-Le Deng
- Department of Data and Analytics, WuXi Diagnostics Innovation Research Institute, Shanghai, China
| | - Jin-Fa Tou
- Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| | - Zhuo Fang
- Department of Data and Analytics, WuXi Diagnostics Innovation Research Institute, Shanghai, China.
| | - Li-Zhong Du
- Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
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Tam PKH, Wells RG, Tang CSM, Lui VCH, Hukkinen M, Luque CD, De Coppi P, Mack CL, Pakarinen M, Davenport M. Biliary atresia. Nat Rev Dis Primers 2024; 10:47. [PMID: 38992031 DOI: 10.1038/s41572-024-00533-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 07/13/2024]
Abstract
Biliary atresia (BA) is a progressive inflammatory fibrosclerosing disease of the biliary system and a major cause of neonatal cholestasis. It affects 1:5,000-20,000 live births, with the highest incidence in Asia. The pathogenesis is still unknown, but emerging research suggests a role for ciliary dysfunction, redox stress and hypoxia. The study of the underlying mechanisms can be conceptualized along the likely prenatal timing of an initial insult and the distinction between the injury and prenatal and postnatal responses to injury. Although still speculative, these emerging concepts, new diagnostic tools and early diagnosis might enable neoadjuvant therapy (possibly aimed at oxidative stress) before a Kasai portoenterostomy (KPE). This is particularly important, as timely KPE restores bile flow in only 50-75% of patients of whom many subsequently develop cholangitis, portal hypertension and progressive fibrosis; 60-75% of patients require liver transplantation by the age of 18 years. Early diagnosis, multidisciplinary management, centralization of surgery and optimized interventions for complications after KPE lead to better survival. Postoperative corticosteroid use has shown benefits, whereas the role of other adjuvant therapies remains to be evaluated. Continued research to better understand disease mechanisms is necessary to develop innovative treatments, including adjuvant therapies targeting the immune response, regenerative medicine approaches and new clinical tests to improve patient outcomes.
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Affiliation(s)
- Paul K H Tam
- Medical Sciences Division, Macau University of Science and Technology, Macau, China.
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
| | - Rebecca G Wells
- Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Clara S M Tang
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Dr. Li Dak-Sum Research Centre, The University of Hong Kong, Hong Kong SAR, China
| | - Vincent C H Lui
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Dr. Li Dak-Sum Research Centre, The University of Hong Kong, Hong Kong SAR, China
| | - Maria Hukkinen
- Section of Paediatric Surgery, Paediatric Liver and Gut Research Group, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Carlos D Luque
- Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Paolo De Coppi
- NIHR Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust and Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Cara L Mack
- Department of Paediatrics, Division of Paediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, USA
| | - Mikko Pakarinen
- Section of Paediatric Surgery, Paediatric Liver and Gut Research Group, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Mark Davenport
- Department of Paediatric Surgery, King's College Hospital, London, UK
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Srivastava A. Improving the Outcome of Biliary Atresia: All Hands on Deck. Indian J Pediatr 2024; 91:649-650. [PMID: 38507130 DOI: 10.1007/s12098-024-05102-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
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Gorbatyuk O, Kurylo H. Biliary atresia in children (analytical literature review and review of own observation). WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:577-584. [PMID: 38691803 DOI: 10.36740/wlek202403129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Aim: to review information resources and analysis of the own experience on this problem for the provision of modern knowledge in the pathogenesis of the pathology, the latest diagnostic and treatment technologies, with consideration of the need to adhere to a single strategy in the management of patients with BA. PATIENTS AND METHODS Materials and Methods: The analysis of the data regarding the results of existing studies evaluating the clinical benefit and safety of diagnostic and treatment methods in Biliary atresia. CONCLUSION Conclusions: BA is the leading cause of neonatal cholestasis development. Early diagnostics of BA, based on the complex evaluation of clinical-laboratory, instrumental and morphological signs of the pathology, has a significant meaning. Surgical correction during the first 2 months of life - the Kasai procedure, as well as dynamic post-surgery follow-up significantly prolong the life of children and allow postponing liver transplantation. The highest patient survival both at the first stage of treatment - conduction of the Kasai procedure and the stage of liver transplantation may be achieved by joined work of surgeons and pediatricians, which allows considering the whole row of possible problems.
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Affiliation(s)
- Olga Gorbatyuk
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE
| | - Halyna Kurylo
- DANYLO HALYTSKY LVIV NATIONAL MEDICAL UNIVERSITY, LVIV, UKRAINE
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Xu X, Zhao Y, Wang X, Zhang R, Liu S, Sun R, Wang Z, Ge L, Sun Y, Zhang S, Ma H, Zhan J. Diagnostic and prognostic value of the gut microbiota and its metabolite butyrate in children with biliary atresia. Pediatr Surg Int 2023; 40:24. [PMID: 38127131 DOI: 10.1007/s00383-023-05606-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To determine the prevalent microbiological profile of biliary atresia (BA) patients at the time of its occurrence by studying their intestinal flora. METHODS A total of 118 gut microbiota samples from three groups of 43 BA patients, 33 disease controls (DC) with other cholestatic diseases and 42 healthy controls (HC), were analyzed by deep mining of public data. Subsequently, a total of 23 fecal samples from three groups of clinically collected patients (11 BA, 6 DC and 6 HC) were sequenced for 16S rRNA gene amplification and analyzed for serum butyrate (BU) level by liquid chromatography. RESULTS Taxonomic analysis revealed significant differences in the composition of the intestinal microbiota between BA patients and controls, with a reduction in diversity and a higher abundance of Proteobacteria, Streptococcus and Lactobacillus in the BA group. Database and clinical data analyses concluded that Streptococcus/Bacteroides (AUC = 0.9035, 95% CI 0.8347-0.9722, P < 0.0001) or Streptococcus/Eggerthella (AUC = 0.8333, 95% CI 0.6340-1.000, P = 0.027) was the best microbiota to differentiate between BA and DC. Serum butyrate levels were low in the BA and DC groups and differed from the HC group (P = 0.01, P = 0.04). Butyrate levels in BA were negatively correlated with jaundice clearance and cholangitis, but not statistically significant. CONCLUSIONS Our study reveals changes in the composition of the gut microbiota in BA, especially the butyrate-producing microbiota, and suggests the potential for using gut microbiota as a noninvasive diagnostic benefit for BA. Low levels of serum butyrate in BA may indicate a poor prognosis.
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Affiliation(s)
- Xiaodan Xu
- Graduate College, Tianjin Medical University, Tianjin, 300070, People's Republic of China
- Department of General Surgery, Tianjin Children's Hospital, LongYan Road 238, Beichen District, Tianjin, 300134, People's Republic of China
| | - Yilin Zhao
- Graduate College, Tianjin Medical University, Tianjin, 300070, People's Republic of China
- Department of General Surgery, Tianjin Children's Hospital, LongYan Road 238, Beichen District, Tianjin, 300134, People's Republic of China
| | - Xueting Wang
- Graduate College, Tianjin Medical University, Tianjin, 300070, People's Republic of China
- Department of Pediatric Surgery, Xinjiang Yili Friendship Hospital, Yili, 835000, People's Republic of China
| | - Ruifeng Zhang
- Graduate College, Tianjin Medical University, Tianjin, 300070, People's Republic of China
- Department of General Surgery, Tianjin Children's Hospital, LongYan Road 238, Beichen District, Tianjin, 300134, People's Republic of China
| | - Shaowen Liu
- Graduate College, Tianjin Medical University, Tianjin, 300070, People's Republic of China
- Department of General Surgery, Tianjin Children's Hospital, LongYan Road 238, Beichen District, Tianjin, 300134, People's Republic of China
| | - Rongjuan Sun
- Graduate College, Tianjin Medical University, Tianjin, 300070, People's Republic of China
- Department of General Surgery, Tianjin Children's Hospital, LongYan Road 238, Beichen District, Tianjin, 300134, People's Republic of China
| | - Zhiru Wang
- Graduate College, Tianjin Medical University, Tianjin, 300070, People's Republic of China
- Department of General Surgery, Tianjin Children's Hospital, LongYan Road 238, Beichen District, Tianjin, 300134, People's Republic of China
| | - Liang Ge
- Department of General Surgery, Tianjin Children's Hospital, LongYan Road 238, Beichen District, Tianjin, 300134, People's Republic of China
| | - Yan Sun
- Department of General Surgery, Tianjin Children's Hospital, LongYan Road 238, Beichen District, Tianjin, 300134, People's Republic of China
| | - Shujian Zhang
- Department of General Surgery, Tianjin Children's Hospital, LongYan Road 238, Beichen District, Tianjin, 300134, People's Republic of China
| | - Hui Ma
- Department of Clinical Laboratory, Tianjin Children's Hospital, Tianjin, 300134, People's Republic of China
| | - Jianghua Zhan
- Department of General Surgery, Tianjin Children's Hospital, LongYan Road 238, Beichen District, Tianjin, 300134, People's Republic of China.
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Wang P, Zhang HY, Yang J, Zhu T, Wu X, Yi B, Sun X, Wang B, Wang T, Tang W, Xie H, Tou J, Han Y, Liu X, Zhan J, Liu Y, Li Y, Lv Z, Lu L, Zhao B, Fu T, Wu D, Bai J, Li W, Yang H, Zhang G, Ren H, Feng J. Severity assessment to guide empiric antibiotic therapy for cholangitis in children after Kasai portoenterostomy: a multicenter prospective randomized control trial in China. Int J Surg 2023; 109:4009-4017. [PMID: 37678274 PMCID: PMC10720810 DOI: 10.1097/js9.0000000000000682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/06/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Cholangitis is common in patients with biliary atresia following Kasai portoenterostomy (KPE). The prompt use of empiric antibiotics is essential due to the lack of identified microorganisms. The authors aimed to validate a severity grading system to guide empiric antibiotic therapy in the management of post-KPE cholangitis. MATERIALS AND METHODS This multicenter, prospective, randomized, open-label study recruited patients with post-KPE cholangitis and was conducted from January 2018 to December 2019. On admission, patients were categorized into mild, moderate, and severe cholangitis according to the severity grading system. Patients in the mild cholangitis group were randomized to receive cefoperazone sodium tazobactam sodium (CSTS) or meropenem (MEPM). Patients with severe cholangitis were randomized to treatment with MEPM or a combination of MEPM plus immunoglobulin (MEPM+IVIG). Patients with moderate cholangitis received MEPM. RESULTS The primary endpoint was duration of fever (DOF). Secondary outcomes included blood culture, length of hospital stay, incidence of recurrent cholangitis, jaundice clearance rate, and native liver survival (NLS). For mild cholangitis, DOF, and length of hospital stay were similar between those treated with CSTS or MEPM (all P >0.05). In addition, no significant difference in recurrence rate, jaundice clearance rate, and NLS was observed between patients treated with CSTS and MEPM at 1-month, 3-month, and 6-month follow-up. In patients with moderate cholangitis, the DOF was 36.00 (interquartile range: 24.00-48.00) h. In severe cholangitis, compared with MEPM, MEPM+IVIG decreased DOF and improved liver function by reducing alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and direct bilirubin at 1-month follow-up. However, recurrence rate, jaundice clearance rate, and NLS did not differ significantly between MEPM+IVIG and MEPM at 1-month, 3-month, and 6-month follow-up. CONCLUSIONS In patients with post-KPE cholangitis, MEPM is not superior to CSTS for the treatment of mild cholangitis. However, MEPM+IVIG treatment was associated with better short-term clinical outcomes in patients with severe cholangitis.
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Affiliation(s)
- Pei Wang
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology; Hubei Clinical Center of Hirschsprung Disease and Allied Disorders, Wuhan
| | - Hong-Yi Zhang
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology; Hubei Clinical Center of Hirschsprung Disease and Allied Disorders, Wuhan
| | - Jixin Yang
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology; Hubei Clinical Center of Hirschsprung Disease and Allied Disorders, Wuhan
| | - Tianqi Zhu
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology; Hubei Clinical Center of Hirschsprung Disease and Allied Disorders, Wuhan
| | - Xiaojuan Wu
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology; Hubei Clinical Center of Hirschsprung Disease and Allied Disorders, Wuhan
| | - Bin Yi
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology; Hubei Clinical Center of Hirschsprung Disease and Allied Disorders, Wuhan
| | - Xiaoyi Sun
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology; Hubei Clinical Center of Hirschsprung Disease and Allied Disorders, Wuhan
| | - Bin Wang
- Department of General Surgery, Shenzhen Children's Hospital, Guangdong
| | - Tao Wang
- Department of General Surgery, Shenzhen Children's Hospital, Guangdong
| | - Weibing Tang
- Department of Neonatal Surgery, Children's Hospital of Nanjing Medical University, Jiangsu
| | - Hua Xie
- Department of Neonatal Surgery, Children's Hospital of Nanjing Medical University, Jiangsu
| | - Jinfa Tou
- Department of Neonatal Surgery, Zhejiang University School of Medicine Children's Hospital, Zhejiang
| | - Yijiang Han
- Department of Neonatal Surgery, Zhejiang University School of Medicine Children's Hospital, Zhejiang
| | - Xiang Liu
- Department of Pediatric Surgery, Anhui Provincial Children's Hospital, Anhui
| | - Jianghua Zhan
- Department of General Surgery, Tianjin Children's Hospital, Tianjin
| | - Yuanmei Liu
- Department of Pediatric General Thoracic and Urology Surgery, The Affiliated Hospital of Zunyi Medical University, Guizhou
| | - Yingchao Li
- Department of Surgery, Second Hospital of Hebei Medical University, Hebei
| | - Zhibao Lv
- Department of General Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai
| | - Li Lu
- Department of General Surgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai
| | - Baohong Zhao
- Department of Neonatal Surgery, Children's Hospital of Shanxi, Shanxi
| | - Tingliang Fu
- Department of Pediatric Surgery, Affiliated Hospital of Binzhou Medical College, Shandong
| | - Dianming Wu
- Department of General Surgery and Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian
| | - Jianxi Bai
- Department of General Surgery and Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian
| | - Wanfu Li
- Department of Pediatric Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Heying Yang
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Guofeng Zhang
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Hongxia Ren
- Department of Neonatal Surgery, Children's Hospital of Shanxi, Shanxi
| | - Jiexiong Feng
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology; Hubei Clinical Center of Hirschsprung Disease and Allied Disorders, Wuhan
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Wang G, Chen H, Sun P, Zhou W, Jiang H, Zhong Z, Chen M, Xie X, Luo Z, Zhou L. Predictive model containing gene signature and shear wave elastography to predict patient outcomes after Kasai surgery in biliary atresia. Hepatol Res 2023; 53:1126-1133. [PMID: 37519259 DOI: 10.1111/hepr.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023]
Abstract
AIMS Infants with biliary atresia (BA) are treated with Kasai portoenterostomy (KPE) surgery, but many BA patients need subsequent salvage liver transplants. The aim of this study is to develop a comprehensive gene-clinical model based on two-dimensional shear wave elastography (2DSWE), liver gene expression, and other clinical parameters to predict response to KPE for BA patients. METHODS Differentially expressed gene patterns between liver samples of BA (n = 102) and non-BA control (n = 14) were identified using RNA sequencing analysis. Biliary atresia patients were then randomly assigned to training and validation cohorts. Gene classifier based on the differentially expressed genes was built in the training cohort. Nomogram models with and without gene classifier were further constructed and validated for predicting native liver survival of BA patients. The utility of the nomograms was compared by C-index. RESULTS Using the least absolute shrinkage and selection operator model, we generated a nine-gene prognostic classifier. The nomogram based on the nine-gene classifier, age, preoperative 2DSWE, and albumin had the better C-index compared to gene classifier alone in the training cohort (0.83 [0.76-0.90] vs. 0.69 [0.61-0.77], p = 0.003) and the validation cohort (0.74 [0.67-0.82] vs. 0.62 [0.55-0.70], p = 0.001). Using risk scores developed from the nomogram, the 12-month survival rates of BA patients with native liver were 35.7% (95% confidence interval [CI], 22.7-56.3) in the high-risk group and 80.8% (95% CI, 63.4-100.0) in the low-risk group in the validation cohort. CONCLUSIONS The comprehensive genetic-clinical nomogram based on preoperative 2DSWE, liver gene expression, and other clinical parameters can accurately predict response to KPE.
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Affiliation(s)
- Guotao Wang
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Huadong Chen
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Panpan Sun
- Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wenying Zhou
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hong Jiang
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhihai Zhong
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Meixi Chen
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhenhua Luo
- Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Luyao Zhou
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, China
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Kotb MA, Ieiri S, Shehata SM. Editorial: Elimination of biliary atresia. Front Pediatr 2023; 11:1202727. [PMID: 37284287 PMCID: PMC10241068 DOI: 10.3389/fped.2023.1202727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/24/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- Magd Ahmed Kotb
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
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Karbasian F, Mashhadiagha A, Anbardar MH, Ataollahi M, Dehghani SM, Honar N, Haghighat M, Imanieh MH, Sayadi M, Shahramian I, Aghsam A, Hosseini A, Mahadavi Mortazavi SM, Darban B, Avazpour A, Mirrahimi B, Ruzbahani AK, Tadayon A. Questioning Diagnostic Value of Serum Matrix Metalloproteinase 7 for Biliary Atresia. J Clin Exp Hepatol 2023; 13:265-272. [PMID: 36950494 PMCID: PMC10025680 DOI: 10.1016/j.jceh.2022.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background Matrix metalloproteinase 7 (MMP7) has been suggested as a promising biomarker in diagnosing biliary atresia (BA). This study aimed to assess the diagnostic accuracy of serum MMP7 in BA in the Middle Eastern population. Methods and materials In this cross-sectional study, neonates and infants with direct hyperbilirubinemia admitted to Namazi referral hospital, Shiraz, Iran, were studied. Baseline demographic and clinical characteristics and blood samples were obtained on admission. MMP7 serum concentration was measured using an enzyme-linked immunosorbent assay (ZellBio GmbH, Ulm, Germany). Results 44 infants with a mean age of 65.59 days were studied. Of these patients, 13 cases were diagnosed with BA, and 31 cases' cholestasis related to other etiologies. Serum MMP7 concertation was 2.13 ng/mL in the BA group and 1.85 ng/mL in the non-BA group. MMP7 was significantly higher in those presented with either dark urine or acholic stool. The predictive performance capability of the MMP7 was not significant in the discrimination of BA from the non-BA group based on receiver operating characteristic curve analysis (area under curve: 0.6, 95% confidence interval: 0.45-0.75). In the optimal cut of point 1.9, the sensitivity and specificity were 84.6% and 45.1%, respectively. Further combination of MMP7 with Gamma-glutamyl transferase (GGT), alkaline phosphatase, direct and total bilirubin, and dark urine or acholic stool was not remarkably boosted the diagnostic accuracy of the test. Interestingly, GGT at a cut-off point of 230 U/L was 84.6% sensitive and 90.3% specific for BA. Conclusion Our results are not consistent with previous studies on this subject. Considering more conventional and available tests like GGT besides conducting future studies with greater samples and different geographical areas is recommended.
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Key Words
- ALP, Alkaline phosphatase
- BA, Biliary atresia
- DB, Direct bilirubin
- GGT, Gamma-glutamyl transferase
- KPE, Kasai portoenterostomy
- LT, Liver transplantation
- MMP7, Matrix metalloproteinase 7
- MRCP, Magnetic resonance cholangiopancreatography
- PFIC, Progressive familial intrahepatic cholestasis
- PIBD, Paucity of interlobular bile ducts
- TSB, Total serum bilirubin
- biliary atresia
- cholestasis
- kasai portoenterostomy
- matrix metalloproteinase 7
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Affiliation(s)
- Fereshteh Karbasian
- Department of Pediatric Gastroenterology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirali Mashhadiagha
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Maryam Ataollahi
- Department of Pediatric Gastroenterology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed M. Dehghani
- Department of Pediatric Gastroenterology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naser Honar
- Department of Pediatric Gastroenterology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Haghighat
- Department of Pediatric Gastroenterology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad H. Imanieh
- Department of Pediatric Gastroenterology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrab Sayadi
- Medical Faculty, Kazerun Branch, Islamic Azad University, Kazerun, Iran
| | - Iraj Shahramian
- Department of Pediatric Gastroenterology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Aghsam
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Hosseini
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Behnaz Darban
- Department of Pediatrics, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Abbas Avazpour
- Department of Pediatrics, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Bahador Mirrahimi
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arian K. Ruzbahani
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ali Tadayon
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
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10
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Arshad A, Gardiner J, Ho C, Rees P, Chadda K, Baker A, Sutcliffe AG. Population-based screening methods in biliary atresia: a systematic review and meta-analysis. Arch Dis Child 2023; 108:468-473. [PMID: 36797045 DOI: 10.1136/archdischild-2022-324946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE The aim of this study was to investigate tested methods of population-based biliary atresia (BA) screening. DESIGN We searched 11 databases between 1 January 1975 and 12 September 2022. Data extraction was independently done by two investigators. MAIN OUTCOME MEASURES Our primary outcomes were: sensitivity and specificity of screening method in BA detection, age at Kasai, BA associated morbidity and mortality, cost-effectiveness of screening. RESULTS Six methods of BA screening were evaluated: stool colour charts (SCCs), conjugated bilirubin measurements, stool colour saturations (SCSs), measurements of urinary sulfated bile acids (USBAs), assessments of blood spot bile acids and blood carnitine measurements.In a meta-analysis, USBA was the most sensitive and specific, with a pooled sensitivity and specificity of 100.0% (95% CI 2.5% to 100.0%) and 99.5% (95% CI 98.9% to 99.8%) (based on one study). This was followed by conjugated bilirubin measurements: 100.0% (95% CI 0.0% to 100.0%) and 99.3% (95% CI 91.9% to 99.9%), SCS: 100.0% (95% CI 0.00% to 100.0%) and 92.4% (95% CI 83.4% to 96.7%), and SCC: 87.9% (95% CI 80.4% to 92.8%) and 99.9% (95% CI 99.9% to 99.9%).SCC reduced the age of Kasai to ~60 days, compared with 36 days for conjugated bilirubin. Both SCC and conjugated bilirubin improved overall and transplant-free survival. The use of SCC was considerably more cost-effective than conjugated bilirubin measurements. CONCLUSION Conjugated bilirubin measurements and SCC are the most researched and demonstrate improved sensitivity and specificity in detecting BA. However, their use is expensive. Further research into conjugated bilirubin measurements, as well as alternative methods of population-based BA screening, is required. PROSPERO REGISTRATION NUMBER CRD42021235133.
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Affiliation(s)
- Adam Arshad
- Population, Policy & Practice Department, UCL GOS Institute of Child Health, London, UK
| | - Julian Gardiner
- Population, Policy & Practice Department, UCL GOS Institute of Child Health, London, UK
| | - Carmen Ho
- Population, Policy & Practice Department, UCL GOS Institute of Child Health, London, UK
| | - Philippa Rees
- Population, Policy & Practice Department, UCL GOS Institute of Child Health, London, UK
| | - Karan Chadda
- Population, Policy & Practice Department, UCL GOS Institute of Child Health, London, UK
| | - Alastair Baker
- Department of Paediatric Hepatology, Kings College Hospital, London, UK
| | - Alastair G Sutcliffe
- Population, Policy & Practice Department, UCL GOS Institute of Child Health, Institute of Child Health, London, UK
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11
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Liu L, Wei L, Qu W, Liu Y, Zeng Z, Zhang H, Li M, Liu J, Wang HL, Li K, He Y, Jia J, Sun L, Zhao X, Zhu Z. Impact of the Kasai Procedure and the Length of Native Liver Survival Time on Outcomes of Liver Transplantation for Biliary Atresia. Liver Transpl 2022; 28:224-235. [PMID: 34482616 DOI: 10.1002/lt.26287] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 12/31/2022]
Abstract
The aim is to explore the impact of the Kasai procedure (KP) and the length of native liver survival time (NLST) on outcomes of liver transplantation (LT). Patients with biliary atresia (BA), who underwent LT in Beijing Friendship Hospital from January 2017 to December 2019, were enrolled and divided into non-KP (N-KP) and post-KP (P-KP) groups. The patients in the P-KP group were further divided into early failure (KP-EF) defined by NLST <1 year, medium failure (KP-MF, NLST 1-5 years), and late failure (KP-LF, NLST >5 years) subgroups. Clinical data at baseline and during follow-up were collected. The inverse probability of treatment weighting method was used to evaluate the independent effect of KP and the length of NLST on clinical outcomes. Among 197 patients with BA, the N-KP group accounted for 43 (21.8%), KP-EF 71 (46.1%), KP-MF 59 (38.3%), and KP-LF 24 (15.6%) cases, respectively. The N-KP and KP-EF groups had significantly longer hospitalization and intensive care unit stays after LT. Graft and overall survival rates were 93.0% in the N-KP group and 97.4% in P-KP group, respectively. The mortality rate in the P-KP group were significantly lower compared with that of the N-KP group with a hazard ratio (HR) of 0.2 (P = 0.02). The risks of biliary and vascular complications and cytomegalovirus (CMV) infection after LT were significantly higher in KP-EF group than those in the KP-MF and KP-LF groups (HRs = 0.09, 0.2, and 0.3, respectively; all P < 0.001). The KP significantly improved after LT overall survival. Patients with early native liver failure after KP have significantly higher risks for biliary and vascular complications and CMV infection.
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Affiliation(s)
- Liwei Liu
- Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lin Wei
- Liver Transplant Center, Clinical Center for Pediatric Liver Transplantation, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei Qu
- Liver Transplant Center, Clinical Center for Pediatric Liver Transplantation, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ying Liu
- Liver Transplant Center, Clinical Center for Pediatric Liver Transplantation, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhigui Zeng
- Liver Transplant Center, Clinical Center for Pediatric Liver Transplantation, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Haiming Zhang
- Liver Transplant Center, Clinical Center for Pediatric Liver Transplantation, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Min Li
- Clinical Epidemiology and Evidence Base Medicine Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jimin Liu
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Hanlin L Wang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine/Ronald Reagan Medical Center, University of California Los Angeles, Los Angeles, CA
| | - Kexin Li
- Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yafei He
- Liver Transplant Center, Clinical Center for Pediatric Liver Transplantation, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jidong Jia
- Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Liying Sun
- Liver Transplant Center, Clinical Center for Pediatric Liver Transplantation, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xinyan Zhao
- Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhijun Zhu
- Liver Transplant Center, Clinical Center for Pediatric Liver Transplantation, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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12
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Liu X, Cao H, Tan X, Shi J, Qiao L, Zhang Q, Shi L. The effect of acetate Ringer's solution versus lactate Ringer's solution on acid base physiology in infants with biliary atresia. BMC Pediatr 2021; 21:585. [PMID: 34930212 PMCID: PMC8686578 DOI: 10.1186/s12887-021-03074-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The choice of the perioperative crystalloid is a key component of the fluid management and must take into account the liver function and the appearing metabolic disorders to avoid increase the liver extra metabolism. The aim of this study is to analyze the effect of acetate Ringer's solution or lactate Ringer's solution in biliary atresia patients. METHODS We included 68 infant patients aged between 21 ~ 65 d, ASA physical status II or III, who underwent elective Kasai hepatoportoenterostomy, received either AR and LR for intravenous fluid resuscitation according to their group allocation. Lactate concentration, serum electrolytes and pH were noteded before skin incision (T1), end of surgery (T2) and postoperative 12 h. We also recorded the time of operation, stay of hospital, loss of blood and urinary, total volume of infusion of crystalloid. RESULTS Lactate level was significantly higher in Group LR than in Group AR patients at T2 (0.76 ± 0.13 versus 0.57 ± 0.22, P = 0.03). Compared with T3, sodium and chlorine were significantly higher in two groups at T2 (145.2 ± 3.1 versus 143.4 ± 3.4 and 104.6 ± 3.7 versus 105.2 ± 2.1). No significant differences were noted in potassium, HCO3- and calcium. There was no statistically significant difference in pH. No glycopenia was recorded in two groups. No significant difference was noted in administration of vasoactive drug (0.7% versus 1%). CONCLUSIONS Resuscitation with AR and LR was associated with similar clinical improvement in infants with biliary atresia. Use of AR reduced the level of lactate comparison with LR.
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Affiliation(s)
- Xiang Liu
- Department of Operating Room and Anesthesiology, The children's hospital of hebei province, No. 133 Jian Hua South Road, Shi Jiazhuang, 050030, China
| | - Hongyan Cao
- Department of Operating Room and Anesthesiology, The children's hospital of hebei province, No. 133 Jian Hua South Road, Shi Jiazhuang, 050030, China
| | - Xiaona Tan
- Department of Neurological Rehabilitation, The children's hospital of hebei province, No. 133 Jian Hua South Road, Shi Jiazhuang, 050030, China
| | - Jing Shi
- Department of Operating Room and Anesthesiology, The children's hospital of hebei province, No. 133 Jian Hua South Road, Shi Jiazhuang, 050030, China
| | - Li Qiao
- Department of Operating Room and Anesthesiology, The children's hospital of hebei province, No. 133 Jian Hua South Road, Shi Jiazhuang, 050030, China
| | - Qi Zhang
- Department of Operating Room and Anesthesiology, The children's hospital of hebei province, No. 133 Jian Hua South Road, Shi Jiazhuang, 050030, China
| | - Lei Shi
- Department of Operating Room and Anesthesiology, The children's hospital of hebei province, No. 133 Jian Hua South Road, Shi Jiazhuang, 050030, China.
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13
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Wang Y, Jia LQ, Hu YX, Xin Y, Yang X, Wang XM. Development and Validation of a Nomogram Incorporating Ultrasonic and Elastic Findings for the Preoperative Diagnosis of Biliary Atresia. Acad Radiol 2021; 28 Suppl 1:S55-S63. [PMID: 32972841 DOI: 10.1016/j.acra.2020.08.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 12/19/2022]
Abstract
RATIONALE AND OBJECTIVES To develop and validate a nomogram that incorporates the gallbladder morphology, hepatic elasticity, and demographic information for the prediction of biliary atresia (BA) in children. MATERIALS AND METHODS A total of 294 consecutive patients under the age of 70 days with cholestasis and suspected symptoms of BA were enrolled in this study, who were divided into a training cohort (150 patients) and a validation cohort (144 patients). Ultrasonography and two-dimensional shear wave elastography were performed for each patient prior to knowing the final diagnosis. Multivariate logistic regression was used to analyze the gallbladder morphologic feature in the sonogram (absence of gallbladder, small gallbladder, lower postprandial gallbladder contractibility, or abnormal gallbladder wall), hepatic elasticity and clinical data from the training cohort, and a diagnostic nomogram for BA was subsequently developed. The performance of the nomogram was respectively evaluated with respect to the discrimination and calibration in every cohort. RESULTS The multivariate analysis showed that the factors of age (p = 0.009), gallbladder morphology (p = 0.001) and hepatic elasticity (p < 0.001) could serve as independent predictive factors to differentiate between BA and other causes of cholestasis. The nomogram incorporating these three parameters showed good discrimination and satisfactory calibration, indicating a better performance compared to using only the gallbladder morphologic features and hepatic elasticity. The observed area under the receiver operator characteristic curve in the training cohort and validation cohort was 0.939 (p < 0.001) and 0.942 (p < 0.001), respectively, with a sensitivity of 95.5% and a specificity of 83.4% in the combined cohort. CONCLUSION The established nomogram shows a favored and improved predictive value for the diagnosis of BA.
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Affiliation(s)
- Yu Wang
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing 100045, China
| | - Li Qun Jia
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing 100045, China
| | - Yan Xiu Hu
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing 100045, China
| | - Yue Xin
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing 100045, China
| | - Xi Yang
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing 100045, China
| | - Xiao Man Wang
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing 100045, China.
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14
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Du J, Shi J, Liu J, Deng C, Shen J, Wang Q. Hemodynamic analysis of hepatic arteries for the early evaluation of hepatic fibrosis in biliary atresia. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 211:106400. [PMID: 34551379 DOI: 10.1016/j.cmpb.2021.106400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Hepatic fibrosis is the prominent characteristic of biliary atresia (BA), may even progress continually after Kasai procedure (KP). BA, as a devastating pediatric hepatic disease, mainly leads to newborn cholestasis, even liver cirrhosis, eventually hepatic failure. Earlier diagnosis of hepatic fibrosis, which used to be detected by liver biopsy commonly, is consistent with better outcomes of KP. Due to potential risks and uncertainty of liver biopsy, it is an urge to seek a safer and more precise evaluation method as alternative. The purpose of this study is to investigate the hemodynamics of hepatic artery (HA) in hepatic fibrosis of early BA based on computational fluid dynamics (CFD) for evaluating the value of CFD for hepatic fibrosis diagnosis. METHODS 40 patients were divided into three groups, including the control group, the abnormal liver function group and the mild to moderate hepatic fibrosis group. CFD was applied to quantify primary hemodynamic parameters of HA and related arteries, including blood flow distribution ratio (FDR), pressure, wall shear stress (WSS) and energy loss (EL). Statistical analyses were also performed to compare the differences amongst these above groups. RESULTS With the progression of hepatic fibrosis, the increasing tendency of hemodynamic parameters values of HA and related arteries were observed. Values of FDR, pressure, WSS and EL of the mild to moderate group was higher than those of the control group and the abnormal liver function group. There were significant differences on FDRAA, FDRHA and EL between the control group and the mild to moderate hepatic fibrosis group (t = 0.037, 0.030 and <0.001, P < 0.05). CONCLUSION Significant variations of HA hemodynamics acquired by CFD between the control group and the mild to moderate hepatic fibrosis group demonstrated the relationship between the progression of hepatic fibrosis and the hemodynamic disorder, and suggested that CFD had the potential to assist the diagnosis of hepatic fibrosis in early BA.
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Affiliation(s)
- Jun Du
- Department of Medical Imaging, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai 200127, China
| | - Jing Shi
- Department of Medical Imaging, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai 200127, China
| | - Jinlong Liu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chaohui Deng
- Department of Gastroenterology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juanya Shen
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Wang
- Department of Medical Imaging, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai 200127, China.
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15
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Tang X, Lv Y, Pu L, Ma J, Jin S, Xiang B. Matrix Metalloproteinase-7 as a Diagnostic Marker for Biliary Atresia: a Systematic Review and Meta-analysis. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03107-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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