联合血液生化指标与弹性成像检查提高胆道闭锁的诊断效能  

The improved performance of hepatic elastography combined with the serum biomarkers for the diagnosis of biliary atresia

作　　者：王玉[1] 贾立群[1] 伏利兵[2] 吕葛[3] 胡艳秀[1] 辛悦[1] 李凤舞 杨曦 王晓曼[1] Wang Yu;Jia Liqun;Fu Libing;Lyu Ge;Hu Yanxiu;Xin Yue;Li Fengwu;Yang Xi;Wang Xiaoman(Department of Ultrasound,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Pathology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Laboratory Center,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院超声科,100045 [2]国家儿童医学中心,首都医科大学附属北京儿童医院病理科,100045 [3]国家儿童医学中心,首都医科大学附属北京儿童医院检验中心,100045

出　　处：《中华超声影像学杂志》2021年第6期500-505,共6页Chinese Journal of Ultrasonography

基　　金：北京市医院管理中心儿科学科协同发展中心专项(XTYB201829)。

摘　　要：目的探讨联合血液生化指标与弹性成像检查对高胆道闭锁的诊断价值。方法连续选取2019年3月至2020年11月于北京儿童医院就诊的疑似胆道闭锁患儿193例,按7∶3比例随机分配组成训练集和验证集。根据训练集病例的血液生化结果、流行病学特征(年龄、性别)及肝脏硬度测值,采用LASSO回归筛选变量,再以二元Logistic回归权重优势比建立胆道闭锁诊断模型,并在训练集与验证集内对其效能进行评价。结果联合丙氨酸转氨酶(alanine aminotransferase,ALT)、γ-谷氨酰转移酶(glutamyl transferase,GGT)与肝脏硬度测值构建的模型,其敏感性为90.9%,特异性为85.7%,训练集与验证集的ROC曲线下面积分别为0.943、0.955,经Hosmer-Lemeshow检验(P=0.292,P=0.951)及校准曲线证实该模型具有满意的校准度。训练集内采用Delong et al.检验提示该模型的效能优于单一建模指标(P<0.001,P=0.016,P<0.001),验证集内决策曲线分析提示在不同阈概率下,采用该模型较弹性成像检查可获得更高的患儿净获益率。结论联合ALT、GGT与肝脏硬度测值构建诊断模型可提高弹性成像对胆道闭锁的鉴别效能。Objective To investigate the improved performance of hepatic elastography combined with the serum biomarkers for the diagnosis of biliary atresia.Methods A total of 193 patients with suspected biliary atresia in Beijing Children′s Hospital from March 2019 to November 2020 were consecutively collected.All patients were randomly divided into the training cohort and validation cohort at a ratio of 7∶3.LASSO regression analysis was used for the selection of the model index based on the data set from the training cohort including the serum biomarkers,demographic features(age and sex)and hepatic elastic measurement,and a diagnostic model for biliary atresia was subsequently developed by weighting on the basis of the dominance ration.The performance of the model was respectively evaluated with respect to the discrimination and calibration in each cohort.Results Alanine aminotransferase(ALT),glutamyl transferase(GGT)and hepatic elastic measurement were selected to build the model.The area under the ROC curve of the final diagnostic model was 0.943 with a sensitivity of 90.9%and a specificity of 85.7%in the training cohort,and 0.955 in the validation cohort.Hosmer-Lemeshow test(P=0.292,P=0.951)and calibration curves further validated its satisfactory calibration in both cohorts.As demonstrated by Delong et al.test,employing the model in the training cohort achieved the best diagnostic performance compared with using single model index(P<0.001,P=0.016,P<0.001).In the validation cohort,the decision curve analysis showed the model had a higher overall net benefit over using hepatic elastography alone in every predicted probability.Conclusions The diagnostic model for biliary atresia,which incorporates ALT,GGT and hepatic elastic measurement,can improve the performance of hepatic elastography with a higher clinical value.

关 键 词：超声检查 胆道闭锁 儿童 弹性成像 

分 类 号：R725.7[医药卫生—儿科]