临床小儿外科杂志2024，Vol.23Issue(12)：1149-1154,6.DOI:10.3760/cma.j.cn101785-202405033-008
超声联合谷氨酰转肽酶检测对产前诊断的胆总管囊肿穿孔风险的预测价值研究
Application value of natal ultrasonographic combined with gamma-glutamyl transpeptidase testing in assessing the risk of choledochal cyst perforation
摘要
Abstract
Objective To explore the value of combining natal ultrasonographic and serum gamma-glu-tamyl transpeptidase(GGT)testing from pregnancy to pre-surgery in assessing the risk of choledochal cyst(CDC)perforation diagnosed prenatally.Methods Data were collected from 435 children diagnosed prenatal-ly with CDC,including natal ultrasonographic data from pregnancy to per-surgery and pre-surgical liver function indicators.The 435 children were randomly divided into a modeling set(n=326)and a validation set(n=109)in a 3:1 ratio.The 326 children in the modeling set were further divided into perforation and non-perfora-ted groups based on intraoperative diagnosis.The differences in various indicators between the two groups were compared,and a diagnostic model was established through logistic regression analysis.The model's diagnostic performance for prenatal CDC perforation was evaluated using the Hosmer-Lemeshow(HL)test and the receiv-er operating characteristic(ROC)curve.The model was then evaluated in the validation set.Results Among the 326 children in the modeling set,43 were in the perforation group and 283 in the non-perforation group.Age at surgery,GGT,direct bilirubin(DB),total bilirubin(TB),and total growth rate of cyst volume from pregnan-cy to pre-surgery were correlated with prenatal CDC perforation(P＜0.05).Multivariate logistic regression in-dicated that the total growth rate of cyst volume and GGT were independent risk factors for CDC perforation.A diagnostic model was established based on these indicators.ROC results showed that the optimal cut-off value for the total growth rate of cyst volume was 1.00 cm3/week,with an area under the ROC curve(AUC)of 0.849,sensitivity of 87.0％,and specificity of 73.4％.The optimal cut-off value for GGT was 150.85 IU/L,with an AUC of 0.796,sensitivity of 84.2％,and specificity of 61.4％.The model's AUC was 0.915,with sen-sitivity and specificity improved to 92.1％and 82.6％,respectively.HL test indicated P=0.805.In the valida-tion set,the model's AUC was 0.858,with sensitivity and specificity of 92.9％and 73.7％,respectively.Conclusions The total growth rate of cyst volume and GGT testing from pregnancy to pre-surgery can help as-sess the risk of CDC perforation diagnosed prenatally and predict the likelihood of perforation.Combined use of these two indicators can improve the sensitivity and specificity of prediction,enhancing the effectiveness of per-foration risk assessment and has good application value.关键词
超声检查/肝功能试验/产期诊断/胆总管囊肿/穿孔Key words
Ultrasonography/Liver Function Tests/Choledochal Cyst/Prenatal Diagnosis/Perforation引用本文复制引用
李思源,刁美,李龙..超声联合谷氨酰转肽酶检测对产前诊断的胆总管囊肿穿孔风险的预测价值研究[J].临床小儿外科杂志,2024,23(12):1149-1154,6.基金项目
北京市医院管理中心登峰人才培养计划(DFL20221101) （DFL20221101）
小儿外科微创诊疗体系建设,中国医学科学院医学与健康科技创新工程(2021RU015) Beijing Hospitals Authority's Ascent Plan(DFL20221101) （2021RU015）
Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment,Chinese Academy of Medical Sciences(2021RU015) （2021RU015）
