肝功能生化指标在婴儿胆道闭锁诊断中的应用  

Application of biochemical indexes of liver function in diagnosis of infantile biliary atresia

作　　者：盛哲 王杰 徐锦 朱海燕 钱燕斐 SHENG Zhe;WANG Jie;XU Jin;ZHU Haiyan;QIAN Yanfei(Clinical Laboratory Center,Children′s Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院临床检验中心,上海201102

出　　处：《检验医学与临床》2023年第6期776-781,786,共7页Laboratory Medicine and Clinic

摘　　要：目的研究血γ-谷氨酰转移酶(GGT)、直接胆红素(DBIL)、总胆红素(TBIL)、总胆汁酸(TBA)对婴儿胆道闭锁(BA)的诊断价值。方法选取2018年10月至2021年10月入院治疗的604例胆汁淤积症患儿作为研究对象。按照胆管造影和肝活检组织学检查结果将患儿分为BA组(n=288)和非BA胆汁淤积组(n=316),再按月龄分为<1月龄组、1~<2月龄组、2~<3月龄组和3~<4月龄组。分别比较BA组和非BA胆汁淤积组,以及各月龄组中BA组和非BA胆汁淤积组GGT、DBIL、TBIL、TBA水平。对差异有统计学意义的指标进行受试者工作特征(ROC)曲线分析,计算曲线下面积(AUC)和最佳临界值,最后将每个月龄组AUC面积较大的前两项指标进行联合诊断的ROC曲线分析。结果BA组与非BA胆汁淤积组间年龄、性别比较差异无统计学意义(P>0.05);各月龄组中BA组与非BA胆汁淤积组间性别、年龄比较差异均无统计学意义(P>0.05)。BA组GGT、DBIL、TBIL、TBA水平均明显高于非BA胆汁淤积组(P<0.001)。GGT诊断BA的AUC最大,为0.884,当GGT为206.75 U/L时,诊断BA的灵敏度、特异度分别为87.5%、79.1%。<1月龄组TBA诊断BA的AUC最大,为0.884,其次为GGT;当TBA为57.20μmol/L时,诊断BA的灵敏度、特异度分别为72.0%、85.0%。1~<2月龄组、2~<3月龄组和3~<4月龄组中GGT诊断BA的AUC均最大(0.876、0.903、0.886),其次为DBIL。1~<2月龄组、2~<3月龄组和3~<4月龄组GGT的最佳临界值分别为205.85、214.85、242.30 U/L;<1月龄组TBA联合GGT诊断BA的AUC为0.950;1~<2月龄组、2~<3月龄组和3~<4月龄组中GGT联合DBIL诊断BA的AUC分别为0.910、0.921、0.907。结论GGT对0~4月龄BA患儿均具有良好诊断价值;TBA仅在<1月龄BA患儿中具有较高诊断意义。DBIL对0~4月龄BA患儿均具有较好诊断价值。相较于单一指标,联合指标诊断效能均有明显提升。Objective To study the diagnostic value of serumγ-glutamyl transpeptidase(GGT),direct bilirubin(DBIL),total bilirubin(TBIL)and total bile acid(TBA)in biliary atresia(BA).Methods A total of 604 infantile patients with cholestasis hospitalized and treated in this hospital from October 2018 to October 2021 were enrolled as the study subjects.According to the results of intraoperative cholangiography and histology of liver biopsy,they were divided into the BA group(n=288)and non-BA cholestasis group(n=316).According to the month age,the infantile patients were divided into the<1 month group,1-<2 month group,2-<3 month group and 3-<4 month group.Then the levels of serum GGT,DBIL,TBIL and TBA were compared between the BA group and non-BA cholestasis group,between the BA group and non-BA cholestasis group among the different month age groups.The indicators with statistical difference conducted the receiver operating characteristic(ROC)curve analysis,the area under the curve(AUC)and the optimal cut-off value for diagnosis were calculated.Finally,the combined ROC analysis was performed on the first two indexes with large AUC area in each month age group.Results There was no statistically significant difference in age and sex between the BA group and non-BA cholestasis group(P>0.05);in each month group,the sex and age had no statistical difference between the two groups(P>0.05);the levels of serum GGT,DBIL,TBIL and TBA in the BA group were significantly higher than those in the non-BA cholestasis group(P<0.001).AUC of GGT for diagnosing BA was the highest,which was 0.884,when GGT was 206.75 U/L,its sensitivity and specificity for diagnosing BA were 87.5%and 79.1%respectively.AUC of TBA for diagnosing BA in the<1 month group was the highest,which was 0.884,followed by GGT,when TBA was 57.20μmol/L,the sensitivity and specificity for diagnosing BA were 72.0%and 85.0%respectively.AUC of GGT for diagnosing BA in the 1-<2 months old group,2-<3 months old group and 3-<4 months old group was the largest(0.876,0.903,0.886),follow

关 键 词：胆道闭锁 Γ-谷氨酰转移酶 直接胆红素 总胆红素 总胆汁酸 

分 类 号：R725.7[医药卫生—儿科] R446.1[医药卫生—临床医学]