预测肝门区囊肿患儿发生囊肿型胆道闭锁风险的列线图开发与验证  

Development and validation of a nomogram to predict risk of cystic biliary atresia in children with hepatic hilar cysts

作　　者：朱莉玲 于红奎 贺雪华 张遇乐 王娜 林泽锋 Zhu Liling;Yu Hongkui;He Xuehua;Zhang Yule;Wang Na;Lin Zefeng(De partment of Ultrasound,Guangzhou Women and Children's Medical Center,Guangzhou 510120,Guangdong Province,China;De partment of Pediatric Surgery,Guangzhou Women and Children's Medical Ce enter,Guangzhou 510120,Guangdong Province,China)

机构地区：[1]广州市妇女儿童医疗中心超声科,广州510120 [2]广州市妇女儿童医疗中心外科,广州510120

出　　处：《中华妇幼临床医学杂志（电子版）》2023年第2期168-177,共10页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家自然科学基金青年项目(82101808);广州市科技计划项目(202102020196)。

摘　　要：目的按探讨超声联合血液生化指标,构建肝门区囊肿(HHC)患儿发生囊肿型胆道闭锁(CBA)风险列线图预测模型。方法选择2016年1月至2022年3月于广州市妇女儿童医疗中心,进行肝门-空肠吻合术(Kasai手术)治疗的134例HHC患儿(日龄<120d)为研究对象。采取回顾性分析法,按照患儿腹腔镜下胆道造影术或Kasai手术中切除组织的组织病理学检查结果,将其分别纳人CBA组(n=54)与胆总管囊肿(CC)组(n=80)。收集2组患儿的年龄、性别、术前超声征象及血液生化指标。采用logistic回归分析方法筛选预测HHC患儿发生CBA的独立预测因子,并使用R软件rms程序包绘制HHC患儿发生CBA风险的列线图。采用受试者工作特征曲线(ROC)及曲线下面积(AUC)、校准曲线、Hosmer-Lemeshow检验及决策曲线分析(DCA)评价该列线图模型预测效能。采用bootstrap方法对该列线图模型进行内部验证。2组患儿进行HHC超声检查时日龄、性别构成比等一般临床资料比较,差异均无统计学意义(P>0.05)。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果果①2组患儿HHC最大长径、最大横径,空腹胆囊形态异常、肝门区纤维斑块、肝门淋巴结肿大、肝内胆管扩张、HHC内胆泥沉积发生率,以及血清总胆红素(TBIL)、直接胆红素(DBIL)、-谷氨酰氨基转移酶(GGT)浓度分别比较,差异均有统计学意义(P<0.05)。②多因素非条件logistic回归分析结果显示,HHC最大长径、空腹胆囊形态异常、肝内胆管扩张、血清DBIL浓度均为HHC患儿发生CBA的独立影响因素(OR=0.871、70.251、0.007、1.089,95%CI:0.780~0.972、2.445~2018.581、0~0.530、1.026~1.156,P=0.014、0.013、0.025、0.005),并根据这4项因素建立预测HHC患儿发生CBA风险的列线图模型。③该列线图模型预测HHC患儿发生CBA风险的AUC为0.996(95%CI:0.991~1.000,P<0.001),说明该模型对HHC患儿发生CBA和CC区分度好,其预测HObjective To establish a prediction model based on ultrasonic features combined with biochemical parameters to predict the risk for cystic biliary atresia(CBA)in neonates and infants with hepatic hilar cysts(HHC).Methods A total of 134 children aged under 120 days with HHC who received Kasai operation in Guangzhou Women and Children's Medical Center from January 2016 to March 2022 were selected as research subjects.According to results of intraoperative laparoscopic cholangiography and histopathological examination of Kasai operation,they were divided into the CBA group(n=54)and choledochal cyst(CC)group(n=80)by retrospective method.The age,gender,preoperative ultrasonographic features and biochemical indicators of two groups were retrospectively collected.Logistic regression analysis method was used to identify the independent predictors of CBA in children with HHC and a nomogram was developed by using R software with package"rms".The performance of the nomogram was assessed by receiver operator characteristic curve(ROC)and area under curve(AUC),calibration curve,Hosmer-Lemeshow test and decision curve analysis(DCA).Bootstrap was performed for internal model validation of the nomogram.There were no statistical differences in age of ultrasonography for HHC and gender constituent ratio between two groups(P>0.05).The procedures followed in this study were in accordance with the Helsinki Declaration of the World Medical Association revised in 2013.Results ① There were significant differences in the maximum length diameter of HHC,the maximum width diameter of HHC,incidence of abnormal gallbladder morphology,portal fibrous plaque,enlargement of portal lymph node,intrahepatic bile duct dilatation,and biliary sludge in HHC,as well as serum total bilirubin(TBIL),direct bilirubin(DBIL),-glutamyltransferase(GGT)levels between two groups(P<0.05).②Multivariate logistic analysis indicated that the maximum length diameter of HHC,abnormal gallbladder morphology,intrahepatic bile duct dilatation and serum DBIL level all were

关 键 词：胆道闭锁 囊肿型 月胆总管囊肿 肝门区囊肿 予预测模型 交列线图 儿童 

分 类 号：R726.5[医药卫生—儿科]