肝胆显像结合血清γ－GT/TBA比值对先天性肝外胆道闭锁的诊断价值  

Diagnostic value of hepatobiliary imaging combined with serum γ-GT/TBA ratio in children with congenital extrahepatic biliary atresia

作　　者：周辉 李俊红[1] 李蔼峰[1] 韦海莲 韦智晓[1] 张筱楠[1] 彭盛梅[1] Zhou Hui;Li Junhong;Li Aifeng;Wei Hailian;Wei Zhixiao;Zhang Xiaonan;Peng Shengmei(Department of Nuclear Medicine,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院核医学科,南宁530021

出　　处：《中华核医学与分子影像杂志》2018年第11期736-740,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：广西医疗卫生适宜技术开发与推广应用项目（S201669）

摘　　要：目的探讨6 h 99Tcm－二乙基乙酰苯胺亚氨二醋酸（EHIDA）肝胆显像结合血清γ－谷氨酰转移酶（γ－GT）/总胆汁酸（TBA）比值（即联合诊断）对小儿先天性肝外胆道闭锁（CEBA）的诊断价值。方法回顾性分析2013年5月至2017年3月间194例（男118例，女76例，平均日龄70.9 d）均行手术治疗的黄疸患儿临床资料，根据手术评价结合病理诊断分为CEBA组（113例）和婴儿肝炎综合征（IHS）组（81例）。分别检测血清γ－GT、TBA含量，并计算γ－GT/TBA比值，同时行99Tcm－EHIDA肝胆动态显像。比较2组间γ－GT和TBA含量、γ－GT/TBA比值，绘制各自受试者工作特征（ROC）曲线，并确定诊断CEBA的阈值。同时比较6 h肝胆显像、γ－GT含量、γ－GT/TBA比值及联合诊断对CEBA的诊断效能。采用两样本t检验和χ2检验分析数据。结果2组间γ－GT/TBA比值、γ－GT和TBA含量差异均有统计学意义（t值：8.217、9.298和2.426，均P〈0.05），γ－GT/TBA比值和γ－GT含量诊断CEBA的效能较高[ROC曲线下面积（AUC）分别为0.863、0.884]。6 h核素肝胆显像诊断CEBA的灵敏度、特异性、准确性及阳性预测值分别为91.15%（103/113）、39.51%（32/81）、69.59%（135/194）和67.76%（103/152）；γ－GT的相应参数分别为69.91%（79/113）、93.83%（76/81）、79.90%（155/194）和94.05%（79/84）；γ－GT/TBA比值的相应参数分别为71.68%（81/113）、92.59%（75/81）、80.41%（156/194）和93.10%（81/87）。6 h肝胆显像的灵敏度优于γ－GT及γ－GT/TBA比值（χ2值：16.256和14.154，均P〈0.05），但特异性、准确性和阳性预测值低于γ－GT/TBA比值（χ2值：50.899、6.062和20.054，均P〈0.05）。联合诊断与6 h显像相比，诊断CEBA的特异性、准确性和阳性预测值均提高（χ2值：56.786、34.168和31.335，均P〈0.05），分别达95.06%（77/81）、92.78%（180/194）和96.26%（103/107）。结论6 h 99Tcm－EHIDA肝胆显ObjectiveTo study the diagnostic value of hepatobiliary imaging at 6 h post-injection of 99Tcm-diethyl iminodiacetic acid （EHIDA） （HI-6） combined with serum gamma-glutamyltransferase （γ-GT）/total bile acid （TBA） ratio （combined diagnosis） in children with congenital extrahepatic biliary atresia （CEBA）.MethodsClinical data of 194 pediatric patients （118 males, 76 females, mean 70.9 d） with jaundice from May 2013 to March 2017 were retrospectively analyzed. All patients underwent surgery. According to the operation and pathologic diagnosis, patients were divided into CEBA group （113 cases）, infant hepatitis syndrome （IHS） group （81 cases）. Serum γ-GT, TBA and the ratio of γ-GT/TBA of the 2 groups were compared. Receiver operating characteristic （ROC） curves were drawn to determine threshold values of the 3 parameters for diagnosis of CEBA. Patients also underwent 99Tcm-EHIDA hepatobiliary dynamic imaging. The diagnostic efficacies of HI-6, γ-GT, γ-GT/TBA ratio, and combined diagnosis were compared. Two-sample t test and χ2 test were used to analyze the data.ResultsThere were significant differences in γ-GT/TBA ratio, γ-GT and TBA content between the 2 groups （t values： 8.217, 9.298 and 2.426, all P〈0.05）. The serum γ-GT and γ-GT/TBA ratio had high diagnostic accuracies （area under ROC curve （AUC）： 0.884 and 0.863）. The sensitivity, specificity, accuracy and positive predictive value of HI-6 in the diagnosis of CEBA were 91.15%（103/113）, 39.51%（32/81）, 69.59%（135/194） and 67.76%（103/152）; the parameters of γ-GT were 69.91%（79/113）, 93.83%（76/81）, 79.90%（155/194） and 94.05%（79/84）; and those of γ-GT/TBA ratio were 71.68%（81/113）, 92.59%（75/81）, 80.41%（156/194） and 93.10%（81/87）. The sensitivity of HI-6 was significantly higher than that of γ-GT and GGT/TBA ratio （χ2 values： 16.256 and 14.154, both P〈0.05）, but the specificity, accuracy and positive predictive value were significantly low

关 键 词：胆道闭锁 放射性核素显像 Γ-谷氨酰转移酶 胆汁酸类和盐类 99m锝二乙基-亚氨 基二乙酸 

分 类 号：R725.7[医药卫生—儿科] R816.92[医药卫生—临床医学]