| Objective: To study the noninvasive related blood test in biliary atresia patients,analyze the relationship between hepatic fibrosis process and relevant blood test data,provide some valuable data for the clinical diagnosis of biliary atresia and liver fibrosis grade.Methods: 1. The blood and liver tissue from January 2010 to December 2014 of children with BA were collected who were operated on kasai surgery during the Tianjin Children's Hospital Kasai surgery, each group 54 cases, including 24 males,30 females,is Kasai group. Collecting another 10 cases of blood and liver tissue of children with liver hemangiomas during the same period admitted to Tianjin Children's Hospital whose liver and biliary system were checked as normal tissue, 6males, 4 females,is control group; 20 cases of blood and liver tissue from January2012 to January 2015 in children with BA underwent liver transplant surgery, 12 males and 8 females,is liver transplant group. To observe the intrahepatic portal area,community boards, fiber spacing and other structures by HE, Masson, CK19 staining.These liver tissues were divided into 0-6 levels based on "BA liver fibrosis grading standards".2 To draw children's femoral vein 3-4ml who was fasting state in the early morning and quiet environment, according to the situation 0-6 grade level were divided into0-6 groups. Each group need detect fibronectin(Fn) content in the blood and analysis the relationship between Fn content of children with BA and hepatic fibrosis process.In addition, to collect blood biochemistry index before operation more than 3-10 days of BA patients, including alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bile acid(TBA), bilirubin and its components,and integrated study the association between blood ALT, AST, bilirubin and bile acid content and hepatic fibrosis progression of children with BA.Results: 1. The histologic appearance of liver in each groupIn the 10 cases of liver hemangioma, only a small amount of bile duct and no or few inflammatory cells infiltration can see in the portal area,the board structure and P- P area structure is clear, bile duct is well developed, no fibrous tissue hyperplasia;in the54 cases of children with BA,in the portal tracts and P- P area has a large number of bile duct hyperplasia, lumen deformity or atresia, in the portal area,Hyperplasia of inflammatory cells and bile duct cells resulting in different degrees of portal area widened,there are different level of inflammatory cells, and bile duct cell infiltration in board structure,Original hepatocytes,and fiberboard disappear, portal area and P- P area has different degrees of fibrous tissue hyperplasia, proliferation of inflammatory cells, bile duct cells and fibroblastssuch along with the boundary of plate structure gradually grow into hepatic lobule, bridging fibrosis, occasional pseudolobule, 20 cases of BA liver transplantation period with rare portal area structure, with microscope there are a large number of abnormal bile duct hyperplasia, a large number of bile duct obstruction in the mesenchyme, with fiber cells, inflammatory cells infiltration in the lumen,etc.what's more in the BA transplantion group,intrahepatic widespread and severe hyperplasia of fibrous microscopically.2. The relationship between the level of Fn and liver function with liver fibrosis in BA Serum Fn was the highest in 0 level children.With the aggravating circumstances of liver fibrosis in children,the serum Fn was gradually reduced of all level children.Liver function enzymes in ALT?AST??-GT?ALP and bile acid at 1-3 level were piecemeally increased with the deterioration of liver cirrhosis.And the above indicators were gradually descend at 4-6 level children.But ALT and AST were declined after a brief wobble at 5 level children which may explained by the improvement of liver function after Kasai operation and then the liver cirrhosis contining worsen.Bilirubin and its components at 1-3 level were increasing,and there was “biliary enzyme separation” phenomenon at 3-4 level which indicated that liver function was worsen.At 4-6 level,it was gradually decreased with the aggravation of liver cirrhosis.Conclusions:1.The content of serum Fn in BA patients gradually reduce with fibrosis progress and the degree of reduction may help determine the process of liver fibrosis.2.The liver fuctions during the process of liver fibrosis development show dynamic changes. For the grade 1 to 3 of liver fibrosis, liver function deteriorate significantly;for the grade 3 to 4,the phenomena of "bile enzyme separation" take place indicating fibrosis is about to progresses to cirrhosis;for grade 4 to 6, liver function deteriorated further and liver enzymes and bilirubin are all lowered. |
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