超声联合VEGFA诊断胆道闭锁的价值分析

doi:10.7517/issn.1674-0475.220504

摘要/Abstract

摘要： 为了考察超声联合血管内皮生长因子A （VEGFA）诊断胆道闭锁（BA）的价值。本研究对108例疑似BA的胆汁淤积患者进行超声检查，获取胆囊长径、肝门部纤维块厚度和肝脏硬度值。通过ELISA法检测胆汁淤积患者和健康者的血清VEGFA。结果显示，BA患者的胆囊长径低于非BA患者，而肝门部纤维块厚度和肝脏硬度值均高于非BA患者（P<0.001）。BA和非BA患者的血清VEGFA水平高于健康者，而BA患者的血清VEGFA水平高于非BA患者（P<0.001）。三项超声参数联合诊断BA的AUC （0.948）和特异性（98.25%）高于单独诊断。血清VEGFA诊断BA的AUC、敏感性和特异性分别为0.850、78.43%和77.19%。超声参数联合血清VEGFA诊断BA的AUC、敏感性和特异性分别为0.978、98.04%和89.47%。超声参数联合血清VEGFA诊断BA的敏感性高于单独诊断及超声参数联合诊断，特异性仅次于超声参数联合诊断，该诊断方法具有较高的临床应用价值。

关键词: 超声, 胆道闭锁, 血管内皮生长因子A, 胆囊长径, 肝门部纤维块厚度, 肝脏硬度值

Abstract: In order to investigate the value of ultrasound combined with vascular endothelial growth factor A (VEGFA) in the diagnosis of biliary atresia (BA), this study examined 108 patients with cholestasis suspected of BA by ultrasonography, and obtained the long diameter of the gallbladder, the thickness of the hilar fibrous mass and the liver stiffness. Serum VEGFA of patients with cholestasis and healthy subjects was detected by ELISA. The results showed that the long diameter of gallbladder in BA patients was lower than that in non-BA patients, while the thickness of hepatic hilar fibrous mass and liver stiffness were higher than those in non-BA patients (P<0.001). Serum VEGFA levels in BA and non-BA patients were higher than those in healthy people, while BA patients had higher serum VEGFA levels than non-BA patients (P<0.001). The combined AUC (0.948) and specificity (98.25%) of the three ultrasound parameters for the diagnosis of BA were higher than those for the diagnosis alone. The AUC, sensitivity and specificity of serum VEGFA for diagnosing BA were 0.850, 78.43% and 77.19%,respectively. The AUC, sensitivity and specificity of ultrasound parameters combined with serum VEGFA in the diagnosis of BA were 0.978, 98.04% and 89.47%,respectively. The sensitivity of ultrasound parameters combined with serum VEGFA in the diagnosis of BA are higher than those of single diagnosis and combined diagnosis of ultrasound parameters, and the specificity is second only to the combined diagnosis of ultrasound parameters. This diagnostic method has high clinical application value.

Key words: ultrasound, biliary atresia, vascular endothelial growth factor A, long diameter of gallbladder, hepatic hilar fibrous mass thickness, liver stiffness value

吴晶晶, 秦鑫, 陈蝶, 韩笑, 赵妍妍, 张博洋, 秦闻. 超声联合VEGFA诊断胆道闭锁的价值分析[J]. 影像科学与光化学, 2022, 40(5): 1045-1050.

WU Jingjing, QIN Xin, CHEN Die, HAN Xiao, ZHAO Yanyan, ZHANG Boyang, QIN Wen. Value Analysis of Ultrasound Combined with VEGFA in Diagnosis of Biliary Atresia[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(5): 1045-1050.

参考文献

[1] Vij M, Rela M. Biliary atresia:Pathology, etiology and pathogenesis[J]. Future Science OA, 2020, 6(5):FSO466.
[2] Kim J R, Hwang J Y, Yoon H M, et al. Risk estimation for biliary atresia in patients with neonatal cholestasis:Development and validation of a risk score[J]. Radiology, 2018, 288(1):262-269.
[3] Sanchez-Valle A, Kassira N, Varela V C, et al. Biliary atresia:Epidemiology, genetics, clinical update, and public health perspective[J]. Advances in Pediatrics, 2017, 64(1):285-305.
[4] Visrutaratna P. Biliary atresia:Making the diagnosis by the gallbladder ghost triad[J]. Pediatric Radiology, 2003, 33(12):902-903.
[5] Choi S O, Park W H, Lee H J, et al. ‘Triangular cord’:A sonographic finding applicable in the diagnosis of biliary atresia[J]. Journal of Pediatric Surgery, 1996, 31(3):363-366.
[6] Nizery L, Chardot C, Sissaoui S, et al. Biliary atresia:Clinical advances and perspectives[J]. Clinics and Research in Hepatology and Gastroenterology, 2016, 40(3):281-287.
[7] 高洋, 唐毅, 王荞, 等. 声脉冲辐射力弹性成像技术检测正常儿童肝脏弹性[J]. 中国医学影像技术, 2014, 30(12):1865-1868.
[8] 段星星, 彭娅, 刘凌萍, 等. 剪切波弹性成像在超声诊断胆道闭锁中的应用价值[J]. 中华超声影像学杂志, 2018, 27(11):942-947.
[9] Clauss M, Gerlach M, Gerlach H, et al. Vascular permeability factor:A tumor-derived polypeptide that induces endothelial cell and monocyte procoagulant activity, and promotes monocyte migration[J]. The Journal of Experimental Medicine, 1990, 172(6):1535-1545.
[10] Yoo S A, Bae D G, Ryoo J W, et al. Arginine-rich anti-vascular endothelial growth factor (anti-VEGF) hexapeptide inhibits collagen-induced arthritis and VEGF-stimulated productions of TNF-alpha and IL-6 by human monocytes[J]. Journal of Immunology, 2005, 174(9):5846-5855.
[11] Claesson-Welsh L, Welsh M. VEGFA and tumour angiogenesis[J]. Journal of Internal Medicine, 2013, 273(2):114-127.
[12] Liu B L, Wei J L, Li M, et al. Association of common genetic variants in VEGFA with biliary atresia susceptibility in Northwestern Han Chinese[J]. Gene, 2017, 628:87-92.
[13] Lee S M, Cheon J E, Choi Y H, et al. Ultrasonographic diagnosis of biliary atresia based on a decision-making tree model[J]. Korean Journal of Radiology, 2015, 16(6):1364-1372.
[14] 黄志华, 董永绥, 熊证明, 等. 婴儿肝炎综合征与胆道闭锁的早期鉴别诊断[J]. 临床儿科杂志, 1996, 14(4):251-252.
[15] 钟雪梅, 张艳玲. 肝内外胆管异常性婴儿肝炎综合征[J]. 实用儿科临床杂志, 2011, 26(7):471-473.
[16] Guibaud L, Lachaud A, Touraine R, et al. MR cholangiography in neonates and infants:Feasibility and preliminary applications[J]. American Journal of Roentgenology, 1998, 170(1):27-31.
[17] Zhou L Y, Shan Q Y, Tian W S, et al. Ultrasound for the diagnosis of biliary atresia:A meta-analysis[J]. AJR American Journal of Roentgenology, 2016, 206(5):W73-W82.
[18] Roquete M L V, Ferreira A R, Fagundes E D, et al. Accuracy of echogenic periportal enlargement image in ultrasonographic exams and histopathology in differential diagnosis of biliary atresia[J]. Journal de Pediatria, 2008, 84(4):331-336.
[19] 卫晶丽, 刘百灵, 杨礼, 等. 胆道闭锁的相关超声参数的Logistic回归分析[J]. 中国医疗设备, 2019, 34(10):82-85.
[20] El-Guindi M A S, Sira M M, Sira A M, et al. Design and validation of a diagnostic score for biliary atresia[J]. Journal of Hepatology, 2014, 61(1):116-123.
[21] Kim W S, Cheon J E, Youn B J, et al. Hepatic arterial diameter measured with US:Adjunct for US diagnosis of biliary atresia[J]. Radiology, 2007, 245(2):549-555.
[22] Mittal V, Saxena A K, Sodhi K S, et al. Role of abdominal sonography in the preoperative diagnosis of extrahepatic biliary atresia in infants younger than 90 days[J]. American Journal of Roentgenology, 2011, 196(4):W438-W445.
[23] Park H, Park J Y, Kim D Y, et al. Characterization of focal liver masses using acoustic radiation force impulse elastography[J]. World Journal of Gastroenterology, 2013, 19(2):219-226.
[24] 刘丹丹, 詹江华, 高伟, 等. 胆道闭锁患者肝门的病理解剖学研究[J]. 临床小儿外科杂志, 2015, 14(1):20-24.
[25] 王霞, 董凤群, 李红艳, 等. 超声高频凸阵探头在婴儿胆道闭锁诊断中的价值[J]. 中国临床医学影像杂志, 2013, 24(8):591-593.
[26] Leschied J R, Dillman J R, Bilhartz J, et al. Shear wave elastography helps differentiate biliary atresia from other neonatal/infantile liver diseases[J]. Pediatric Radiology, 2015, 45(3):366-375.
[27] Nakamura K, Tanoue A. Etiology of biliary atresia as a developmental anomaly:Recent advances[J]. Journal of Hepato-Biliary-Pancreatic Sciences, 2013, 20(5):459-464.
[28] Edom P T, Meurer L, da Silveira T R, et al. Immunolocalization of VEGF A and its receptors, VEGFR1 and VEGFR2, in the liver from patients with biliary atresia[J]. Applied Immunohistochemistry & Molecular Morphology, 2011, 19(4):360-368.
[29] Simons M, Gordon E, Claesson-Welsh L. Mechanisms and regulation of endothelial VEGF receptor signalling[J]. Nature Reviews Molecular Cell Biology, 2016, 17(10):611-625.