肝功能相关指标诊断婴儿胆道闭锁的价值  

Value of liver function index in the diagnosis of biliary atresia in infants

作　　者：殷润开[1] 赵瑞芹[1] 付海燕[1] 白革兰[1] 李海花[1] 殷春兰[1] 石伟娜[1] 刘亚丽 程丽娟 贾霄云 李桂桂 赵世光 李晓雷 YIN Runkai;ZHAO Ruiqin;FU Haiyan;BAI Gelan;LI Haihua;YIN Chunlan;SHI Weina;LIU Yali;CHENG Lijuan;JIA Xiaoyun;LI Guigui;ZHAO Shiguang;LI Xiaolei(Department of Digestive Diseases,Hebei Children′s Hospital,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院消化科,石家庄050031

出　　处：《实用医学杂志》2021年第12期1607-1612,共6页The Journal of Practical Medicine

基　　金：河北省重点研发计划项目(健康医疗与生物医药专项)(编号:18277726D)。

摘　　要：目的探讨血γ⁃谷氨酰转肽酶(GGT)、直接胆红素(DB)、总胆汁酸(TBA)、谷丙转氨酶(ALT)对婴儿胆道闭锁(BA)的诊断价值。方法选取2013年1月至2020年1月住院治疗的胆汁淤积症患儿544例作为研究对象。根据胆道造影结果将患儿分为BA组(n=268)和非BA胆汁淤积组(n=276),然后对每组患儿根据月龄再次分为1~2月龄组、2~3月龄组和≥3月龄组。分别比较BA组和非BA胆汁淤积组,以及各月龄组BA组和非BA胆汁淤积组GGT、DB、TBA、ALT水平。将差异有统计学意义的指标纳入受试者工作特征曲线(ROC)分析,计算ROC曲线下面积(AUC)和最佳诊断界值。结果胆汁淤积的发病年龄BA组早于非BA组(P<0.05),两组间性别比较差异无统计学意义(P>0.05);各月龄组中两组间性别比较差异均无统计学意义(P>0.05);BA组DB、ALT、TBA、GGT水平均明显高于非BA胆汁淤积组(P<0.001);GGT的AUC最大,为0.828(95%CI:0.794~0.863),当GGT取值276 U/L时,诊断BA的敏感度和特异度分别为70.8%、80.1%;1~2月龄组和2~3月龄组中均GGT的AUC最大,分别为0.857(95%CI:0.804~0.910)、0.883(95%CI:0.828~0.939),诊断界值分别为194 U/L、340 U/L;≥3月龄组DB的AUC最大,为0.758(95%CI:0.674~0.841);当DB取值112.45μmmol/L时,诊断BA的敏感度和特异度分别为81.3%、64.8%。结论GGT和DB对BA均具有良好的诊断价值;GGT对1~3月龄BA患儿具有良好诊断价值;对于≥3月龄BA患儿,DB具有更好的诊断意义。Objective To investigate the value of serumγ⁃glutamyl transpeptidase(GGT),direct biliru⁃bin(DB),total bile acid(TBA)and alanine amino transferase(ALT)in the diagnosis of biliary atresia(BA).Methods A total of 544 infants with cholestasis who were hospitalized and received treatment from January 2013 to January 2020 were enrolled in this study.According to the results of intraoperative cholangiography,they were divided into BA group with 268 infants and non⁃BA cholestasis group with 276 infants.Serum levels of GGT,DB,TBA and ALT were compared between the two groups.According to the age,infants were divided into 1~2 month group,2~3 month group and over 3 month group,and the four indexes were also analyzed among 3 group.A receiver operating characteristic(ROC)curve analysis was performed for indexes with statistical significance,and the area under the ROC curve(AUC)and the optimal cut⁃off value for diagnosis were calculated.Results The BA group had a younger age of onset than that in the non⁃BA cholestasis group(P<0.05).There was no signifi⁃cant difference in sex between the two groups,while the BA group had significantly higher serum levels of GGT,DB,TBA and ALT than those in the non⁃BA cholestasis group(P<0.001).GGT had the highest AUC of 0.828(95%CI:0.794~0.863)in the diagnosis of BA,and at the optimal cut⁃off value of 276U/L it had a sensitivity of 70.8%and a specificity of 80.1%.GGT also had the highest AUC in the 1~2 month group(AUC=0.857,95%CI:0.804~0.910)and 2~3 month group(AUC=0.883,95%CI:0.828~0.939)with the cut⁃off values of 194 U/L,340 U/L.DB had the highest AUC of 0.758(95%CI:0.674~0.841)in the over 3 month group,and at the opti⁃mal cut⁃off value of 112.45μmmol/L,it had a sensitivity of 81.3%and a specificity of 64.8%.Conclusions Both GGT and DB had good diagnostic value for BA.GGT had good diagnostic value for children aged 1~3⁃month partic⁃ularly,while DB had better diagnostic value for children aged over 3 months.

关 键 词：胆道闭锁 γ⁃谷氨酰转肽酶 直接胆红素 总胆汁酸 谷丙转氨酶 

分 类 号：R725.7[医药卫生—儿科]