上海地区胆道闭锁筛查报告  

Preliminary report for screening biliary atresia in Shanghai

作　　者：沈桢[1] 董瑞[1] 汪吉梅[2] 刘江勤 顾琴 李志奇 唐征 丁艳 严卫丽 郑珊[1] Shen Zhen;Dong Rui;Wang Jimei;Liu Jiangqin;Gu Qin;Li Zhiqi;Tang Zheng;Ding Yan;Yan Weili;Zheng Shan(Department of Pediatric Surgery,Children's Hospital of Fudan University,Shanghai 201102,China;Department of Neonatology,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200433,China;Department of Neonatology,Shanghai First Maternity&Infant Hospital,Shanghai 200040,China;Department of Neonatology,Shanghai Changning Maternity&Infant Hospital,Shanghai 200000,China;Department of Obstetrics,International Peace Maternity&Child Health Hospital of China Welfare Institute,Shanghai 200030,China;Department of Neonatology,International Peace Maternity&Child Health Hospital of China Welfare Institute,Shanghai 200030,China;Department of Clinical Epidemiology,Children's Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院外科,上海201102 [2]复旦大学附属妇产科医院新生儿科,上海200433 [3]上海市第一妇婴保健院新生儿科,200040 [4]上海长宁区妇幼保健院新生儿科,200000 [5]上海国际和平妇幼保健院产科,200030 [6]上海国际和平妇幼保健院新生儿科,200030 [7]复旦大学附属儿科医院临床流行病学研究室,上海201102

出　　处：《中华小儿外科杂志》2020年第11期989-993,共5页Chinese Journal of Pediatric Surgery

基　　金：上海市市级医院新兴前沿技术联合攻关项目(SHDC12014106)。

摘　　要：目的探讨基于婴儿大便色卡的筛查方案在上海地区进行胆道闭锁筛查的可行性和有效性。方法于2015年1月1日至2016年10月31日向在上海四家产科医院出生的新生儿家长发放新生儿大便色卡并宣教使用方法。新生儿回家后,家长若发现存在黄疸且大便颜色异常,可直接联系胆道闭锁筛查中心进行进一步检查。若未联系,产科医院会于新生儿42 d回访时回收色卡,并按照筛查方案向本筛查中心传报疑似病例,由筛查中心追踪至诊断或排除胆道闭锁。所有确诊胆道闭锁患儿均需经胆道造影和/或胆道探查明确诊断。以家长在42 d回访前联系胆道闭锁筛查中心并被识别或在42 d回访时被产科医院识别并传报为胆道闭锁患儿被成功筛查的标准。统计上海地区胆道闭锁发病情况,并通过计算本次筛查敏感度、特异性、手术日龄及早期手术率,分析其对胆道闭锁早期诊断及治疗的影响。结果上海市四家胆道闭锁诊治中心数据汇总显示,本次研究期间上海地区总共出生41例胆道闭锁患儿,发病率为10.86/10万活婴(41/377420,95%CI:7.80~17.74)。共有95例疑似患儿被筛查中心识别,11例患儿被确诊为胆道闭锁,其中9例在42 d回访前自行联系本中心;5例被漏筛。筛查项目的敏感度为11/16(68.6%)、特异性为99.93%(128498/128582)、阳性预测值为11.6%(11/95)、阴性预测值为99.99%(128498/128503)。成功筛查患儿(11例)与未进入筛查系统或漏筛患儿(29例)比较,手术日龄平均提前42.4 d(47.6±14.6 vs.90.0±16.3,P<0.001),早期手术率(手术日龄<60 d)显著提升(90%vs.0)。结论在上海地区利用大便色卡开展胆道闭锁筛查项目是可行的,可有效提高胆道闭锁患儿早期手术率,对改善患儿预后具有积极意义,有推广价值。Objective To evaluate the feasibility and effectiveness of stool color card based screening program for biliary atresia(BA)and calculate the incidence of BA in Shanghai.Methods Infant stool color card was distributed to parents with neonates born from January 2015 to October 2016 at four maternity hospitals in Shanghai.Stool colors were observed by parents.Upon finding acholic stools,a screening center was contacted.At 42-day postnatal health checkup,medical staff checked the count and reported suspected cases.Operative age was compared between infants successfully screened out and those missed by the screening system or born at other hospitals.Results A total of 41 BA infants were born in Shanghai with an incidence of 10.86/100000 live births(41/377420,95%CI:7.80-17.74).Among 16 BA infants,11 were screened out.Ninety-six infants were recognized as suspected cases.The values of sensitivity,specificity,positive and negative predictive were 11/16(68.6%),99.93%(128498/128582),11.6%(11/95)and 99.99%(128498/128503)respectively.Those infants screened out were referred earlier(33.6±5.2 vs.67.5±17.5,P<0.001)and were operated sooner(47.6±14.6 vs.90.0±16.3,P<0.001)than those who were not screened out or born at other hospitals(n=29).Rate of infants operated before 60 days was significantly higher than that of controls(90%vs.0).Conclusions Infant stool color card based screening program is both feasible and efficient for early detection of BA.

关 键 词：胆道闭锁 筛查 发病率 

分 类 号：R726.5[医药卫生—儿科]