Ⅲ型胆道闭锁患儿术前基质金属蛋白酶水平与Kasai手术后预后的相关性研究  

Prognostic value of preoperative serum levels of MMPs in children of biliary atresia

作　　者：胡书奇 韩一江 赵晓霞[1] 方舒 赖登明 陈锐[1] 黄寿奖[1] 吕成杰[1] 秦琪[1] 钭金法[1] Hu Shuqi;Han Yijiang;Zhao Xiaoxia;Fang Shu;Lai Dengming;Chen Rui;Huang Shoujiang;Lyu Chengjie;Qin Qi;Tou Jinfa(Department of Neonatal Surgery,The Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Children's Health,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属儿童医院新生儿外科,国家儿童健康与疾病临床医学研究中心,杭州310000

出　　处：《临床小儿外科杂志》2024年第8期723-728,共6页Journal of Clinical Pediatric Surgery

基　　金：2020年度国家中心自主设计项目(SZOC0004)。

摘　　要：目的探索Ⅲ型胆道闭锁患儿术前血清基质金属蛋白酶(matrix metalloproteinases,MMPs)系列蛋白与肝纤维化程度及Kasai术后黄疸清除率、早期胆管炎和中长期自体肝生存的相关性,寻找预测胆道闭锁Kasai手术预后的相关因子。方法回顾性分析2017年3月至2018年6月浙江大学医学院附属儿童医院新生儿外科确诊为Ⅲ型胆道闭锁并行Kasai手术的患儿术前血清MMPs蛋白水平,收集患儿术后肝脏病理、术后3个月黄疸消退情况、术后早期胆管炎情况以及术后5年自体肝生存情况。分析不同预后组别患儿术前血清MMPs系列蛋白水平,评估术前血清MMPs蛋白与预后的关系。结果本研究共纳入38例患儿,男22例、女16例,3例术中造影确诊为Ⅲ型胆道闭锁后家属拒绝行Kasai术,仅行肝脏活检术;35例确诊后行Kasai术及肝脏活检术,术后均获随访,其中6例于术后1年内行肝移植手术,2例因胆道闭锁相关并发症死亡,27例随防5年以上均自体肝存活。术后3个月黄疸消退组和黄疸未消退组比较、自体肝存活组和非自体肝存活组比较,术前血清MMPs系列蛋白水平差异均无统计学意义(P>0.05)。早期胆管炎组术前血清MMP-7为(29967.89±15079.03)pg/mL,无早期胆管炎组为(15071.77±10988.75)pg/mL,差异有统计学意义(t=2.978,P<0.05)。轻度肝纤维化组术前血清MMP-7为9103.31(4603.54,16759.18)pg/mL,重度肝纤维化组为20288.52(11146.71,28581.65)pg/mL,差异有统计学意义(Z=-2.285,P<0.05)。轻度肝纤维化组术前血清MMP-13为1396.81(1295.41,1748.79)pg/mL,重度肝纤维化组为1193.47(1013.33,1485.17)pg/mL,差异有统计学意义(Z=-1.972,P<0.05)。结论胆道闭锁患儿术前血清MMP-7和MMP-13与Kasai术后早期胆管炎以及肝脏纤维化程度相关,可望作为预测胆道闭锁部分预后指标的一项潜在因子。Objective To explore the correlation between preoperative serum matrix metalloproteinases(MMPs)levels and liver fibrosis,as well as the jaundice clearance rate,early cholangitis,and medium-to-long-term native liver survival following the Kasai procedure in children with TypeⅢbiliary atresia,in order to identify predictive factors for the prognosis of biliary atresia after Kasai surgery.Methods A retrospective analysis was conducted on the preoperative serum MMPs protein levels of children diagnosed with TypeⅢbiliary atresia who underwent the Kasai procedure at the Department of Neonatal Surgery,Children's Hospital,Zhejiang University School of Medicine,procedure from March 2017 to June 2018.Postoperative data included liver pathology,jaundice resolution at 3 months,early cholangitis,and 5-year native liver survival.Serum MMPs levels were analyzed in relation to different prognostic outcomes.Results A total of 38 children were included in this study,including 22 males and 16 females.3 children,diagnosed with TypeⅢbiliary atresia intraoperatively,had their families refuse the Kasai procedure and only underwent liver biopsy.Of the 35 patients who proceeded with the Kasai procedure and liver biopsy,6 underwent liver transplantation within 1 year post-surgery,2 died due to biliary atresia-related complications,and 27 survived with native liver for over 5 years.There were no statistically significant differences in preoperative serum MMPs levels between the jaundice resolution and non-resolution groups,or between the native liver survival and non-survival groups.However,preoperative serum MMP-7 levels were significantly higher in the early cholangitis group(29967.89±15079.03 pg/mL)compared to the non-cholangitis group(15071.77±10988.75 pg/mL)(t=2.978,P<0.05).For liver fibrosis,MMP-7 levels were higher in the severe fibrosis group compared to the mild fibrosis group(Z=-2.285,P<0.05).MMP-13 levels were lower in the severe fibrosis group compared to the mild fibrosis group(Z=-1.972,P<0.05).Conclusions Preoperative

关 键 词：胆道闭锁 基质金属蛋白酶类 肝纤维化 黄疸 胆管炎 存活率 数据相关性 

分 类 号：R73[医药卫生—肿瘤]