肝胆显像、肝功各酶及胆红素对婴儿黄疸的鉴别  

Differentiation between Infantile Hepatitis Syndrome and Biliary Atresia with Hepatobiliary Scintigraphy and Laboratory Examination Results

作　　者：林琛[1] 方琳丽[1] 王鲁华[1] 欧阳亮[1] 李俊雄[1] 林玫瑞[2] 

机构地区：[1]汕头大学医学院第一附属医院核医学科,广东省汕头市515041 [2]汕头大学医学院第一附属医院ICU,广东省汕头市515041

出　　处：《中华全科医学》2010年第2期146-147,共2页Chinese Journal of General Practice

基　　金：2008年广东省汕头市重点科技项目(汕府科[2008]85号)

摘　　要：目的研究放射性核素肝胆显像、肝功各酶及胆红素的测定对临床难以鉴别的婴儿肝炎综合征(IHS)和先天性胆道闭锁(EHBA)婴儿持续性黄疸的价值。方法采用速率生化分析法检测36例临床难以鉴别IHS和EHBA的婴儿持续性黄疸空腹血清谷草转氨酶(AST),血清谷丙转氨酶(ALT),血清乳酸脱氢酶(LDH),血清谷氨酰转肽酶(GGT),血清碱性磷酸酶(ALP),血清总胆红素(TBILI),血清直接胆红素(DBILI)及血清间接胆红素(IBILI)。并于当天对患儿行肝胆显像。结果肝胆显像诊断IHS灵敏度为85%(17/20),特异度为100%(16/16);诊断EHBA灵敏度为100%(16/16),特异度为85%(17/20)。患儿血清AST、ALT、LDH、GGT、ALP、TBILI、DBILI及IBILI含量高于参考值范围;TBILI及DBILI的含量在EHBA组高于IHS组(P<0.05)。AST、LDH、ALT、GGT、ALP及IBILI含量在IHS与EHBA组差别无统计学意义(P>0.05)。结论婴儿持续性黄疸均有肝损害。肝胆显像、血清肝功各酶及胆红素测定能无创、安全、较准确地鉴别IHS与EHBA,提高IHS和EHBA患者的诊断,对于婴儿持续性黄疸治疗的选择有重要意义。Objective To investigate the value of hepatobiliary scintigraphy and laboratory examination results in the different diagnosis between infantile hepatitis syndrome（IHS） and congenital extrahepatic biliary atresia（EHBA）.Methods The sera of 36 infants with persistent jaundice were collected and separately detected for AST,ALT,LDH,GGT,ALP,TBILI,DBILI and IBILI by biochemical assay.And the hepatobiliary scintigraphy was performed meanwhile.Results The sensitivity of hepatobiliary scintigraphy in detecting IHS and EHBA in 36 infants was 85%（17/20）and 100%（16/16）,specificity was 100%（16/16）and 85%（17/20）.The levels of AST,LDH,ALT,GGT,ALP,TBILI,IBILI and DBILI were above the reference range.The levels of TBILI and DBILI were higher in infants with EHBA than in infants with IHS（P0.05）,whereas the levels of AST,LDH,ALT,GGT,ALP and IBILI were similar between them（P0.05）.Conclusion Hepatic damage is common in infants with IHS and EHBA.Hepatobiliary scintigraphy combined with laboratory examination results is of value to the differential diagnosis between IHS and EHBA.

关 键 词：放射性核素显像 乳儿肝炎综合征 胆道闭锁 肝功能检验 

分 类 号：R722.19[医药卫生—儿科] R817.4[医药卫生—临床医学]