Background

Biliary atresia (BA) is a rare fatal liver disease in children, and the aim of this study was to develop a method to diagnose BA early.

Methods

We determined serum levels of matrix metalloproteinase-7 (MMP-7), the results of 13 liver tests, and the levels of 20 bile acids, and integrated computational models were constructed to diagnose BA.

Results

Our findings demonstrated that MMP-7 expression levels, as well as the results of four liver tests and levels of ten bile acids, were significantly different between 86 BA and 59 non-BA patients (P < 0.05). The computational prediction model revealed that MMP-7 levels alone had a higher predictive accuracy [area under the receiver operating characteristic curve (AUC) = 0.966, 95% confidence interval (CI): 0.942, 0.989] than liver test results and bile acid levels. The AUC was 0.890 (95% CI 0.837, 0.943) for liver test results and 0.825 (95% CI 0.758, 0.892) for bile acid levels. Furthermore, bile levels had a higher contribution to enhancing the predictive accuracy of MMP-7 levels (AUC = 0.976, 95% CI 0.953, 1.000) than liver test results. The AUC was 0.983 (95% CI 0.962, 1.000) for MMP-7 levels combined with liver test results and bile acid levels. In addition, we found that MMP-7 levels were highly correlated with gamma-glutamyl transferase levels and the liver fibrosis score.

Conclusion

The innovative integrated models based on a large number of indicators provide a noninvasive and cost-effective approach for accurately diagnosing BA in children.

Video Abstract (MP4 142103 KB)

中文翻译：

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利用 MMP-7 水平和胆汁酸的集成模型准确预测胆道闭锁

背景

胆道闭锁（BA）是一种罕见的致命性儿童肝脏疾病，本研究的目的是开发一种早期诊断胆道闭锁的方法。

方法

我们测定了血清基质金属蛋白酶 7 (MMP-7) 水平、13 项肝脏检查结果和 20 种胆汁酸水平，并构建了综合计算模型来诊断 BA。

结果

我们的研究结果表明，86 名 BA 和 59 名非 BA 患者的 MMP-7 表达水平以及四项肝脏检查结果和十种胆汁酸水平存在显着差异（P  < 0.05）。计算预测模型显示，单独使用 MMP-7 水平比肝脏测试结果和胆汁酸水平具有更高的预测准确性 [受试者工作特征曲线下面积 (AUC) = 0.966，95% 置信区间 (CI)：0.942，0.989] 。肝脏测试结果的 AUC 为 0.890 (95% CI 0.837, 0.943)，胆汁酸水平的 AUC 为 0.825 (95% CI 0.758, 0.892)。此外，与肝脏检测结果相比，胆汁水平对提高 MMP-7 水平预测准确性的贡献更大（AUC = 0.976，95% CI 0.953，1.000）。 MMP-7 水平与肝脏测试结果和胆汁酸水平相结合的 AUC 为 0.983 (95% CI 0.962, 1.000)。此外，我们发现MMP-7水平与γ-谷氨酰转移酶水平和肝纤维化评分高度相关。

结论

基于大量指标的创新集成模型为准确诊断儿童 BA 提供了一种无创且经济有效的方法。

视频摘要 (MP4 142103 KB)