血清胆汁酸水平对胆道闭锁Kasai术后退黄成功患儿预后评估的价值研究OA北大核心CSTPCD

Objective To explore the value of serum bile acid levels in the prognostic evaluation of chil-dren with successful jaundice resolution after the Kasai procedure for biliary atresia(BA).Methods A retro-spective analysis was conducted on clinical data of 115 children with BA who underwent the Kasai procedure and achieved normal total bilirubin levels between January 2020 and December 2021 at Children's Hospital of Fudan University.Based on serum bile acid levels at 6 months post-surgery,patients were divided into ≤34 µmol/L and＞34 µmol/L groups.Postoperative laboratory indices,including liver function,coagulation func-tion,platelet count,spleen size,and liver shear wave elastography were compared between the two groups.The incidence of sentinel events,including thrombocytopenia,splenomegaly,gastroesophageal varices or gastrointesti-nal bleeding,and liver transplantation,was also analyzed.Results Among the 115 patients with normal total bilirubin,serum bile acid levels at 6 months post-surgery ranged from 3 to 263 μmol/L(median 34 μmol/L).There was a strong correlation between bile acid levels at 6 months and 24 months post-surgery(r=0.623,P＜0.001).Compared to the＞34 μmol/L group,the ≤34 μmol/L group had significantly lower levels of total bil-irubin[6.5(5.5,10.4)μmol/L vs.9.1(6.8,12.9)μmol/L],aspartate aminotransferase[48(37,72)U/L vs.88(55,118)U/L],alanine aminotransferase[39(24,70)U/L vs.70(35,98)U/L],gamma-glutamyl transfer-ase[73(30,182)U/L vs.115(45,270)U/L],bile acid levels[21(11,34)μmol/L vs.80(29,162)μmol/L],spleen length[0(0,10)mm vs.16(0,40)mm],and liver shear wave elastography values[1.4(1.2,1.6)m/s vs.1.6(1.3,1.9)m/s],while serum albumin[43(41,44)g/L vs.43(38,44)g/L]and platelet counts[214(149,318)× 109/L vs.191(96,267)× 109/L]were higher,with statistical significance(P＜0.05).Interna-tional normalized ratio[0.95(0.93,1.03)vs.0.97(0.91,1.08)]and 25-hydroxyvitamin D[34(27,39)ng/mL vs.34(26,37)ng/mL]levels were similar between the groups(P＞0.05).The incidence of thrombocytopenia[26.9％(14/52)vs.50.9％(28/55)],splenomegaly[23.8％(10/42)vs.61.5％(24/39)],and overall senti-nel events[30.8％(16/52)vs.70.9％(39/55)]was significantly lower in the ≤34 μmol/L group(P＜0.05).The liver transplantation rate at 2 years post-surgery was 3.7％(2/54)in the ≤34 μmol/L group,compared to 26.2％(16/61)in the＞34 μmol/L group.Conclusions Elevated serum bile acid levels at 6 months post-Kasai procedure suggest a potential for poorer prognosis in children with BA who initially achieve jaundice resolution.