婴儿胆汁淤积性肝病患儿血清丙氨酸转氨酶与临床指标的相关性研究  

Correlation of serum alanine aminotransferase and clinical indicators in infantile cholestatic hepatopathy

作　　者：张领领 鄢素琪[2] 周俪姗[2] 熊小丽[2] 江治霞[2] 吴云涛[2] 丘燕燕 易巍 Zhang Lingling;Yan Suqi;Zhou Lishan;Xiong Xiaoli;Jiang Zhixia;Wu Yuntao;Qiu Yanyan;Yi Wei(Clinical College of Traditional Chinese Medicine,Hubei University of Chinese Medicine,Wuhan 430065,Hubei,China;Department of Integrated Traditional Chinese and Western Medicine,Wuhan Childrens Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430016,Hubei,China)

机构地区：[1]湖北中医药大学中医临床学院,湖北武汉430065 [2]华中科技大学同济医学院附属武汉儿童医院中西医结合科,湖北武汉430016

出　　处：《中国中西医结合急救杂志》2021年第1期63-68,共6页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学基金面上项目(81574024);武汉市卫生和计划生育委员会科研项目(WZ17A07)。

摘　　要：目的探讨婴儿胆汁淤积性肝病(ICH)中血清丙氨酸转氨酶(ALT)水平与相关临床指标的关联性,总结分析ALT在不同病因、病情严重程度ICH中的水平变化,为临床ICH的早期诊断和针对性治疗提供参考.方法选择华中科技大学同济医学院附属武汉儿童医院2014年6月至2019年6月入院诊断为ICH的481例患儿作为研究对象,回顾性分析所有患儿的一般情况、个人史、皮肤发生黄染时间、大小便颜色变化、入院后血生化检测指标,包括肝功能指标〔总胆红素(TBil)、直接胆红素(DBil)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ-谷氨酰转移酶(GGT)、总蛋白(TP)、白蛋白(ALB)、球蛋白(GLB)、白球比(A/G)、碱性磷酸酶(ALP)〕、总胆汁酸(TBA)、肌酸激酶同工酶(CK-MB)、血乳酸(Lac)、凝血功能〔凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)〕、甲胎蛋白(AFP)、血糖(GLU)以及肝、脾、胆囊彩超结果、出院时诊断.根据首次检测ALT水平是否在正常参考值范围(7~45 U/L)及住院期间复查ALT的变化趋势,将所有患儿分为ALT持续正常组(112例,A组)、ALT首次正常后转为异常组(59例,B组)、ALT持续异常组(310例,C组),比较各组上述指标的差异,分析不同ALT水平各组ICH患儿的病因分布以及病情严重程度.结果①各组性别、就诊年龄、喂养方式、皮肤黄染发生时间、大便颜色变化、肝、脾、胆囊彩超结果比较差异均无统计学意义(均P>0.05).②A组患儿出生体重明显低于C组(kg:2.90±0.67比3.07±0.60,P<0.05);B组、C组肝脏肿大范围明显大于A组(cm:1.81±1.56、1.57±1.36比1.21±1.18,均P<0.05).③B组和C组的DBil(μmol/L:83.24±45.03、90.97±50.84比67.41±35.02)、ALB(g/L:38.15±6.16、39.09±4.93比35.16±5.67)均明显高于A组(均P<0.05),C组的AST〔U/L:192.5(123.0,315.5)比74.0(48.5,119.5)、85.0(63.0,124.0)〕、TP(g/L:55.41±6.46比50.46±6.08、52.64±8.15)、A/G(2.28±1.19比1.62±1.35、1.77±1.53)均明Objective To explore the correlations between the levels of serum alanine aminotransferase(ALT)and related clinical indicators in infantile cholestatic hepatopathy(ICH),summarize and analyze the changes of ALT levels in different etiology and severity of ICH,and then to provide reference for early ICH diagnosis and targeted treatment.Methods The 481 ICH infants diagnosed and admitted to Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology from June 2014 to June 2019 were selected,and their clinical data were retrospectively analyzed,including general situation,personal history,jaundice staining occurrence time,color changes of stool and urine,and after admission,the laboratory blood biochemical test indexes such as liver function[total bilirubin(TBil),direct bilirubin(DBil),alanine aminotransferase(ALT),aspartate aminotransferase(AST),7-glutamyl transferase(GGT),total protein(TP),albumin(ALB),globulin(GLB),albumin/globulin ratio(A/G),alkaline phosphatase(ALP)],total bile acid(TBA),creatine kinase isoenzyme(CK-MB),blood lactic acid(Lac),coagulation function[prothrombin time(PI^and activated partial thromboplastin time(APTT)],alpha fetoprotein(AFP),blood glucose(GLU),and liver,spleen and gallbladder color Doppler ultrasound results and diagnosis at discharge were recorded.According to whether the first tested result of ALT was in normal range(7-45 U/L)and changing trend of ALT during hospitalization,the infants were divided into 3 groups:ALT persistently normal group(112 cases,group A),ALT normal initially then abnormal group(59 cases,group B)and ALT persistently abnonnal group(310 cases,group C).The above indexes among 3 groups were compared and the etiological distribution and disease severity of the 3 groups were analyzed.Results①There were no statistical significant differences in gender,age at clinical visit,feeding mode,skin jaundice staining time,color change of stool,results of color Doppler ultrasonography of liver,spleen and gallbladder among 3 groups(all P>0.05

关 键 词：婴儿胆汁淤积性肝病 丙氨酸转氨酶 相关性分析 

分 类 号：R72[医药卫生—儿科]