黄疸型婴儿肝炎预后与血清谷氨酰转肽酶水平变化的关系  

Progonostic value of serum GGT in infants with intrahepatic cholestasis

作　　者：王中林[1] 朱启镕[2] 王晓红[1] 王建设[2] 

机构地区：[1]复旦大学附属儿科医院感染科,上海200032 [2]复旦大学附属儿科医院传染病研究室,上海200032

出　　处：《肝脏》2005年第4期271-274,共4页Chinese Hepatology

基　　金：复旦大学儿科医院重点基金资助项目(ZD03-12)

摘　　要：目的研究血清谷氨酰转肽酶(GGT)水平与黄疸型婴儿肝炎预后的关系。方法回顾性分析38例除外先天性胆道闭锁和其他先天性异常后的黄疸型婴儿肝炎的临床资料,以死亡、肝移植或等待肝移植、1岁后仍持续或反复黄疸为预后不良指标,按最初GGT的高低分为≤50U/L和>50U/L组并分析两组患者的预后有无差别。结果最初的GGT≤50U/L组6例中5例预后不良;>50U/L组32例中3例预后不良,差别有统计学意义(P=0.001)。动态分析发现,8例预后不良患儿中5例GGT始终在正常水平,与胆红素和转氨酶等指标波动无关;3例GGT在开始时升高,随病情进展,反而降为正常。预后良好患儿,随黄疸消退,GGT渐达高峰然后恢复正常。结论在黄疸型婴儿肝炎中,GGT不升或随黄疸加深或持续,GGT反而降为正常,是预后不良的指标;病程中黄疸波动,而GGT始终正常者,需考虑有进行性家族性肝内胆汁淤积可能。Objective Most infants with intrahepatic cholestasis recover completely, only a small proportion of them progress to cirrhosis or death. Some author found that normal or low serum GGT in infants with idiopathic neonatal hepatitis is an indicator of poor prognosis. The aim of this study is to investigate the prognostic value of serum GGT in infants with intrahepatic cholestasis. Methods A retrospective study was conducted in 38 cases of infantile hepatitis, with whom the extrahepatic biliary atresia or other biliary abnormality had been excluded. Children with death, liver transplantation or waiting for liver transplantation, persistent or recurrent jaundice over 1 year of age were regarded as poor prognosis. According to the serum GGT levels at presentation, the 38 patients can be divided into two groups： ≤ 50 U/L and 〉 50 U/L groups. The prognoses were compared between this two groups. Results Patients with GGT≤50 U/L at presentation have poorer prognosis than those with GGT 〉 50 U（ P = 0.001 ）. Poor prognosis was observed in 8 patients. The serum GGT level was normal in 5 of them during the whole follow up period. 2 of this 5 patients died within 1 year. Jaundice persistent or recurrent with persistent pruritus was found in the other 3. 3 of 8 patients who had elevated GGT at presentation, but dropped to normal with the clinical conditions deteriorated. In 72.4% of the cases with good prognosis, AST declined with jaundice when recovered. Levels of GGT reached its peak with the process of remission then dropped to normal in 79.3 % patients with good prognosis. Conclusion GGT might be a prognostic parameter in Chinese intrahepatic cholestasis infants. Low level of GGT in infants with persistent jaundice might indicated failure of liver function. Progressive familial intrahepatic cholestasis may also existed in Chinese infants.

关 键 词：婴儿肝炎 谷氨酰转肽酶 进行性家族性肝内胆汁淤积 

分 类 号：R725.7[医药卫生—儿科]