肝功能相关指标联合胆囊收缩率在诊断胆道闭锁中的应用价值  

Value of liver function index combined with gallbladder contraction rate on the diagnosis of biliary atresia

作　　者：徐鹏飞 张玉凤 王军[1] 唐甜甜[1] 张瑜[1] 邓慧玲[2] Xu Pengfei;Zhang Yufeng;Wang Jun;Tang Tiantian;Zhang Yu;Deng Huiling(The Second Department of Infectious Diseases,Children’s Hospital Affiliated to Xi’an Jiaotong University,Xi’an 710003,Shaanxi Province,China;Department of Pediatrics,Xi’an Central Hospital,Xi’an 710003,Shaanxi Province,China)

机构地区：[1]西安交通大学附属儿童医院感染二科,陕西西安710003 [2]西安市中心医院儿科,陕西西安710003

出　　处：《中国肝脏病杂志（电子版）》2024年第1期45-51,共7页Chinese Journal of Liver Diseases：Electronic Version

基　　金：西安市科技计划项目(23YXYJ0095)。

摘　　要：目的探讨γ-谷氨酰转移酶(gamma-glutamyl transferase,GGT)、直接胆红素(direct bilirubin,DBil)与胆囊收缩率在诊断胆道闭锁(biliary atresia,BA)中的应用价值。方法收集2017年9月至2021年9月在西安交通大学附属儿童医院及西安市中心医院儿科住院治疗的185例胆汁淤积性肝病患儿为研究对象,根据剖腹探查或术中胆道造影和随访情况,将患儿分为BA组(70例)和肝内胆汁淤积(intrahepatic cholestasis,IHC)组(115例)。比较两组患儿的一般临床资料、实验室检查指标[包括总胆红素(total bilirubin,TBil)、DBil、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、GGT、碱性磷酸酶(alkaline phosphatase,ALP)、总胆汁酸(total bile acid,TBA)]及腹部超声检查资料。将有统计学意义的指标纳入受试者工作特征(receiver operator characteristic,ROC)曲线分析,计算ROC曲线下面积、最佳诊断界值和OR值;应用MedCalc软件进行ROC曲线下面积对比,分析各指标对诊断BA的价值。结果BA组和IHC组患儿的性别(男/女:31例/39例比78例/37例)、就诊年龄(中位数:52.0 d比58.0 d)、肝脏肋下大小(中位数:4.0 cm比2.0 cm)、脾大比例[40%(28/70)比18.3%(21/115)]、大便颜色、TBil(中位数:204.35μmol/L比138.30μmol/L)、DBil(中位数:125.70μmol/L比80.00μmol/L)、ALT(中位数:112.00 U/L比71.00 U/L)、AST(中位数:175.00 U/L比120.00 U/L)、GGT(中位数:440.75 U/L比94.50 U/L)、餐后1 h胆囊收缩率(无收缩/有收缩且<50%/有收缩且>50%:52.9%/41.4%/5.7%比7.0%/27.8%/65.2%)差异有统计学意义(P均<0.05)。两组患儿ALP(中位数526.00 U/L比548.00 U/L)、TBA(中位数:143.45μmol/L比161.90μmol/L)和25羟维生素D(中位数:8.00 ng/ml比8.13 ng/ml)水平差异无统计学意义(P均>0.05)。多因素Logistic回归分析表明,DBil(OR=1.031,95%CI:1.015~1.047,P<0.001)、GGT(OR=1.007,95%CI:1.004~1.011,P<0.001)、餐后1 h胆囊无收缩(OR=57.493,95%CI:9.577~345.Objective To investigate the value of gamma-glutamyl transferase(GGT),direct bilirubin(DBil)and gallbladder contraction rate on the diagnosis of biliary atresia(BA).Methods Total of 185 infants with cholestasis in the Children’s Hospital Affiliated to Xi’an Jiaotong University and Xi’an Central Hospital from September 2017 to September 2021 were selected and divided into BA group(70 cases)and intrahepatic cholestasis(IHC)group(115 cases)according to the results of exploratory laparotomy or intraoperative cholangiography and follow-up.The general clinical data,laboratory examination[including total bilirubin(TBil),DBil,alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transpeptidase(GGT),alkaline phosphatase(ALP)and total bile acid(TBA)]and abdominal ultrasonography data were compared between the two groups.Receiver operating characteristic(ROC)curve was performed for indexes with statistical significance.The area under the ROC curve,optimal cut-off value and odds ratio(OR)value were calculated.MedCalc software was used to compare the area under the ROC curve in the diagnosis of BA.Results Gender(male/female:31 cases/39 cases vs.78 cases/37 cases),age(median:52.0 d vs.58.0 d),liver size(median:4.0 cm vs.2.0 cm),proportion of splenomegaly[40%(28/70)vs.18.3%(21/115)],stool color,TBil(median:204.35μmol/L vs.138.30μmol/L),DBil(median:125.70μmol/L vs.80.00μmol/L),ALT(median:112.00 U/L vs.71.00 U/L),AST(median:175.00 U/L vs.120.00 U/L),GGT(median:440.75 U/L vs.94.50 U/L)and gallbladder contraction rate at 1 hour after meal(no contraction/contraction<50%/contraction>50%:52.9%/41.4%/5.7%vs.7.0%/27.8%/65.2%)of infants between the two groups were statistically significant(all P<0.05).There were no significant differences in ALP(median:526.00 U/L vs.548.00 U/L),TBA(median:143.45μmol/L vs.161.90μmol/L)and 25 hydroxyvitamin D(median:8.00 ng/ml vs.8.13 ng/ml)levels of infants between the two groups(all P>0.05).Multivariate Logistic regression analysis showed that DBil(OR=1.031,95%CI:1.015~

关 键 词：Γ-谷氨酰转移酶 直接胆红素 胆囊收缩率 胆道闭锁 肝内胆汁淤积 

分 类 号：R725.7[医药卫生—儿科]