谷氨酰转移酶直接胆红素及天冬氨酸转氨酶诊断胆汁淤积性黄疸患儿胆道闭锁的临床意义  

Clinical significance of glutamyltransferase,direct bilirubin and aspartate aminotransferase in the diagnosis of biliary atresia in cholestatic jaundice

作　　者：纳钊[1] 白强[1] 陈莉[1] 方辉[1] 杨航 颜剑宏 NA Zhao;BAI Qiang;CHEN Li;FANG Hui;YANG Hang;YAN Jian-hong(Department of General Surgery,Kunming Children's Hospital,Kunming,Yunnan 650028,China)

机构地区：[1]昆明市儿童医院普外科,云南昆明650028

出　　处：《中国妇幼保健》2024年第20期3975-3978,共4页Maternal and Child Health Care of China

基　　金：云南省昆明市卫生健康委员会卫生科研项目(2020-04-01-113)。

摘　　要：目的探讨谷氨酰转移酶、直接胆红素及天冬氨酸转氨酶在胆汁淤积性黄疸中诊断胆道闭锁的临床价值及意义。方法选取2020年5月—2022年5月昆明市儿童医院住院胆汁淤积性黄疸患儿172例为研究对象。根据腹腔镜探查、术中胆道造影及随访情况,将患儿分为胆道闭锁组(BA)79例和胆汁淤积组(Non-BA)93例。比较两组首诊日龄、性别、总胆红素(TB)、直接胆红素(DB)、谷氨酰转移酶(GGT)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)及总胆汁酸(TBA)。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(约登指数)。结果两组患儿在ALT、ALP及TBA水平比较差异无统计学意义(P>0.05)。两组患儿在性别构成比略有差异(P<0.05);BA组首诊日龄早于Non-BA组(P<0.05);BA组GGT、TB、DB及AST水平显著高于Non-BA组(P<0.05);GGT诊断BA的AUC最大,为0.897(95%CI:0.848~0.947);当GGT截断值为160.5 U/L,诊断BA的灵敏度和特异度分别为0.899和0.806;GGT+DB、GGT+AST联合诊断BA的AUC分别为0.923(95%CI:0.884~0.962)和0.921(95%CI:0.879~0.964)。结论在胆汁淤积性黄疸中,GGT对胆道闭锁具有较好的诊断价值,GGT联合DB、AST诊断价值优于单一指标。Objective To explore the clinical value and significance of glutamyl transferase,direct bilirubin and aspartate aminotransferase in the diagnosis of biliary atresia in cholestatic jaundice.Methods A total of 172 children with cholestatic jaundice hospitalized in Kunming Children's Hospital from May 2020 to May 2022 were selected as the research subjects.According to the angiography and follow-up,the children were divided into biliary atresia group(BA,79 case)and cholestasis group(Non-BA,93 case).The age at first visit,gender,total bilirubin(TB),direct bilirubin(DB),glutamyl transferase(GGT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP)and total bile acid(TBA)were compared between the two groups.The indicators with statistically significant differences were included in the receiver operating characteristic(ROC)curve analysis,and the area under the ROC curve(AUC)and the best diagnostic value were calculated.Results There was no significant difference in ALT,ALP and TBA levels between the two groups(P>0.05).There was a slight difference in the gender composition between the two groups(P<0.05).The age of the first visit in the BA group was earlier than that in the Non-BA group(P<0.05).The levels of GGT,TB,DB and AST in the BA group were significantly higher than those in the Non-BA group(P<0.05).The AUC of GGT for diagnosing BA was the largest,which was 0.897(95%CI:0.848-0.947).When the cutoff value of GGT was 160.5 U/L,the sensitivity and specificity of diagnosing BA were 0.899 and 0.806,respectively.The AUC of GGT+DB and GGT+AST for the combined diagnosis of BA were 0.923(95%CI:0.884-0.962)and 0.921(95%CI:0.879-0.964).Conclusion In cholestatic jaundice,GGT has a good diagnostic value for biliary atresia,and the diagnostic value of GGT combined with DB and AST is better than that of a single indicator.

关 键 词：胆道闭锁 谷氨酰转移酶 胆汁淤积性黄疸 直接胆红素 天冬氨酸转氨酶 

分 类 号：R604[医药卫生—外科学] R726[医药卫生—临床医学]