GGT联合DBIL、APRI对胆道闭锁的诊断价值  

Diagnostic value of GGT combined with DBIL and APRI in biliary atresia

作　　者：韩一江 胡书奇 陈宝海 黄寿奖[1,2] 秦琪[1,2] 吕成杰 钭金法[1,2] HAN Yijiang;HU Shuqi;CHEN Baohai;HUANG Shoujiang;QIN Qi;LYU Chengjie;TOU Jinfa(Department of Neonatal Surgery,the Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310051,China;National Clinical Research Center for Child Health;Information Centre,the Children's Hospital,Zhejiang University School of Medicine)

机构地区：[1]浙江大学医学院附属儿童医院新生儿外科,310051 [2]国家儿童健康与疾病临床医学研究中心 [3]浙江大学医学院附属儿童医院信息中心

出　　处：《天津医药》2022年第1期11-14,共4页Tianjin Medical Journal

基　　金：国家儿童健康与疾病临床医学研究中心自主设计项目(S20C0004)。

摘　　要：目的探讨谷氨酰转肽酶(GGT)联合直接胆红素(DBIL)、天冬氨酸转氨酶/血小板指数(APRI)诊断胆道闭锁(BA)的价值。方法回顾性分析283例婴儿胆汁淤积性肝病患者的临床资料,经胆道探查、胆道造影及肝活检确诊为BA者138例为BA组,术中排除或内科治疗后黄疸消退者145例为Non-BA组。收集患者首次入院的一般资料、首次同期血液学检查结果,包括日龄、性别、体质量、GGT、DBIL、间接胆红素(IBIL)、总胆汁酸(TBA)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、血小板计数(PLT);并计算APRI。采用ROC曲线评价各指标对BA的诊断价值。结果BA组患者体质量、GGT、TBA、DBIL、IBIL、AST、ALT、APRI水平均显著高于Non-BA组(P<0.05)。ROC曲线显示,GGT诊断BA的曲线下面积(AUC)最大,为0.845(95%CI:0.801~0.890),当GGT为临界值264 U/L时,其敏感度和特异度分别为0.732和0.814;GGT+DBIL、GGT+APRI联合诊断BA的AUC分别为0.880(95%CI:0.840~0.919)和0.871(95%CI:0.830~0.912)。结论GGT对BA具有较好的诊断价值,GGT联合DBIL、APRI对BA的诊断价值优于GGT单独诊断。Objective To investigate the value of gamma-glutamyltransferase(GGT)combined with direct bilirubin(DBIL)and aspartate aminotransferase-to-platelet ratio index(APRI)in the diagnosis of biliary atresia(BA).Methods The clinical data of 283 cases of infantile cholestatic hepatopathy were retrospectively analyzed.A total of 138 cases of BA confirmed by biliary exploration,cholangiography and liver biopsy were included in the BA group,and 145 cases of jaundice eliminated during operation or subsided after medical treatment were included in the non-BA group.The general information and the results of the first simultaneous hematological examination were collected,including age,sex,body weight,GGT,DBIL,indirect bilirubin(IBIL),total bile acid(TBA),aspartate aminotransferase(AST),alanine aminotransferase(ALT)and platelet count(PLT).The APRI was calculated.ROC curve was used to evaluate the diagnostic value of each index for BA.Results Values of body weight,GGT,TBA,DBIL,IBIL,AST,ALT and APRI were significantly higher in the BA group than those in the non-BA group(P<0.05).ROC curve showed that GGT had the largest area under the curve(AUC)for BA diagnosis,which was 0.845(95%CI:0.801-0.890).When GGT was 264 U/L,its sensitivity and specificity were 0.732 and0.814,respectively.The AUC of GGT+DBIL and GGT+APRI for BA were 0.880(95%CI:0.840-0.919)and 0.871(95%CI:0.830-0.912),respectively.Conclusion GGT has better diagnostic value for BA,and GGT combined with DBIL and APRI has better diagnostic value than GGT alone.

关 键 词：胆道闭锁 Γ-谷氨酰转移酶 ROC曲线 直接胆红素 天冬氨酸转氨酶/血小板指数 

分 类 号：R722.17[医药卫生—儿科] R726.1[医药卫生—临床医学]