Objective To evaluate the prognostic value of serum hepatic fibrosis indexes in children undergoing Kasai surgery for biliary atresia.Methods Clinical data of 53 children with biliary atresia undergoing Kasai surgery in the Department of Neonatal Surgery of Anhui Children s Hospital from January 2017 to January 2021 were retrospectively analyzed,including 23 males and 30 females,aged(62.91± 19.93)days.Patients were divided into two groups according to the prognosis.Patients with native liver sur-vival(NLS)≥2 years were classified as good prognosis group(n=31),and patients with NLS＜2 years as poor prognosis group(n=22).Clinical data such as gender,age of operation,gamma-glutamyl transpeptid-ase(GGT),total bilirubin(TBil),direct bilirubin(DBil),liver pathological fibrosis grade,type Ⅳ colla-gen,hyaluronic acid,laminin and type Ⅲ procollagen peptide(PC-Ⅲ)were collected.Postoperative data were collected by outpatient follow-up,telephone and Wechat.Spearman rank correlation test was conducted to determine the correlation between serum liver fibrosis index and liver pathological fibrosis grade.Receiver operating characteristic(ROC)curve was used to analyze the predictive ability of serum hepatic fibrosis indexes for early prognosis.Results Spearman rank correlation test showed that the grade of liver pathologi-cal fibrosis at Kasai surgery was positively correlated with hyaluronic acid(rs=0.558,P＜0.001),type Ⅳcollagen(rs=0.449,P=0.004)and PC-Ⅲ(rs=0.426,P=0.005).Hyaluronic acid was positively cor-related with GGT(rs=0.588),TBil(rs=0.365)and DBil(rs=0.433)(all P＜0.001).Type Ⅳ colla-gen was positively correlated with GGT(rs=0.696),TBil(rs=0.570)and DBil(rs=0.619)(all P＜0.001).PC-Ⅲ was positively correlated with GGT(rs=0.580),TBil(rs=0.484)and DBil(rs=0.538)(all P＜0.001).Compared with the good prognosis group,the hyaluronic acid levels of children in the poor prognosis group at 1 month and 3 months after surgery[1 month:334.1(164.4,776.0)ng/ml vs.116.3(70.0,262.1)ng/ml,Z=2.66,P=0.007;3 months:394.6(161.6,800.0)ng/ml vs.131.9(103.2,189.4)ng/ml,Z=2.39,P=0.016]and type Ⅳ collagen[1 month:640.0(568.0,640.0)ng/ml vs.338.9(234.8,640.0)ng/ml,Z=2.40,P=0.016;3 months:640.0(161.6,800.0)ng/ml vs.277.2(167.7,495.0)ng/ml,Z=2.39,P=0.015]were increased.The PC-Ⅲ level in the poor prognosis group was higher than that in the good prognosis group at 3 months after surgery[550.0(550.0,550.0)ng/ml vs.281.0(199.9,548.1)ng/ml,Z=2.73,P=0.005].The area under ROC curve of hyaluronic acid at 3 months after surgery to predict the prognosis of patients with biliary atresia undergoing Kasai surgery was 0.724(95％CI:0.586-0.986,P=0.006),and the best cut-off value was 215.95 ng/ml,with sensitivity and specificity of 86.4％and 83.9％,respectively.Conclusion High levels of hyaluronic acid at 3 months after Kasai surgery in children with biliary atresia indicates poor prognosis.
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