多指标联合检测在胆总管囊肿和囊肿型胆道闭锁早期鉴别诊断中的应用价值  

Application value of multi-index combined detection in early differential diagnosis of choledochal cyst and cystic biliary atresia

作　　者：王提学 封林[1] 孙明璇 田宇 李龙[3,4] 孙劲松 Wang Tixue;Feng Lin;Sun Mingxuan;Tian Yu;Li Long;Sun Jinsong(Department of Pediatric Surgery,Affiliated Hospital,Jining Medical College,Jining 272007,China;Department of Child Healthcare Zhangdian Maternal&Children’s Health Hospital,Zibo 255022,China;Department of General Surgery,Affiliated Children’s Hospital,Capital Institute of Pediatrics,Beijing 100020,China;Department of Pediatric Surgery,Tsinghua Changgeng Hospital,Beijing 102218,China)

机构地区：[1]济宁医学院附属医院小儿外科,济宁272007 [2]淄博市张店区妇幼保健院儿童保健科,淄博255022 [3]首都儿科研究所附属儿童医院普外科,北京100020 [4]北京清华长庚医院小儿外科,北京102218

出　　处：《临床小儿外科杂志》2024年第12期1155-1159,共5页Journal of Clinical Pediatric Surgery

基　　金：中国医学科学院创新单元(2021RU015);首都临床诊疗技术研究及示范应用(Z191100006619002)。

摘　　要：目的探索血生化指标及多指标联合检测在早期鉴别诊断胆总管囊肿(choledochal cyst,CC)和囊肿型胆道闭锁(cystic biliary atresia,CBA)中的应用价值。方法回顾性分析2013年1月至2022年12月济宁医学院附属医院小儿外科和首都儿科研究所附属儿童医院普外科收治的99例年龄小于45 d的肝门部囊肿患儿临床资料,根据胆道造影及病理结果分为CBA组和CC组,对比两组患儿血液生化指标差异,并使用受试者操作特征(receiver operating characteristic curve,ROC)曲线分析单一生化指标及多指标联合预测模型对于CC和CBA的鉴别诊断效能。结果CBA组37例,男11例、女26例,手术年龄26(18,37)d;CC组62例,男14例、女48例,手术年龄23(13,35)d;两组性别分布及手术年龄差异无统计学意义(P>0.05)。CBA组和CC组术前谷氨酰转肽酶(γ-glutamyl transferase,GGT)分别为456.2(294.0,647.5)U/L、385.6(220.9,611.2)U/L,天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)分别为85.2(42.9,145.1)U/L、57.1(36.6,105.5)U/L,谷丙转氨酶(alanine aminotransferase,ALT)分别为45.6(16.6,91.2)U/L、29.4(15.2,59.3)U/L,差异均无统计学意义(P>0.05);总胆红素(total bilirubin,TBIL)分别为191.8(156.4,227.1)μmol/L、152.5(104.3,200.6)μmol/L,直接胆红素(direct bilirubin,DBIL)分别为66.7(41.0,97.1)μmol/L、47.3(21.8,70.8)μmol/L,总胆汁酸(total bile acid,TBA)分别为91.4(62.1,114.8)μmol/L、61.9(17.5,91.1)μmol/L,差异均有统计学意义(P<0.05)。TBIL、DBIL、TBA、加权预测模型和非加权预测模型的ROC曲线下面积分别为0.658、0.677、0.712、0.752、0.782。结论TBA、TBIL、DBIL对鉴别诊断CC和CBA有一定意义,但多指标联合检测具有更高的诊断效能,有助于CBA和CC的早期鉴别诊断。Objective To explore the application value of biochemical indicators and combined multi-index detection in an early differential diagnosis of choledochal cyst(CC)and cystic biliary atresia(CBA).Methods A retrospective analysis was conducted on the clinical data of 99 infants under 45 days of age with hepatic hilar cysts,treated from January 2013 to December 2022 at the Pediatric Surgery Department of Jining Medical University Affiliated Hospital and General Surgery Department of Capital Institute of Pediatrics Affiliated Children’s Hospital.Based upon cholangiographic and pathological results,they were assigned into two groups of CBA and CC.The differences in biochemical parameters between two groups were compared.And the diagnostic effectiveness of single biochemical parameters and multi-index co-prediction models was analyzed by receiver operating characteristic curve(ROC).Results CBA group was composed of 37 cases(11 males and 26 females)with a median operative age of 26(18,37)days.And CC group included 62 cases(14 males and 48 females)with a median operative age of 23(13,35)days.No statistically significant inter-group differences existed in gender distribution or operative age(P>0.05).Preoperative level ofγ-glutamyl transferase(GGT)were 456.2(294.0,647.5)U/L in CBA group and 385.6(220.9,611.2)U/L in CC group;aspartate aminotransferase(AST)level was 85.2(42.9,145.1)U/L in CBA group and 57.1(36.6,105.5)U/L in CC group;alanine aminotransferase(ALT)was 45.6(16.6,91.2)U/L in CBA group and 29.4(15.2,59.3)U/L in CC group.The inter-group differences were not statistically significant(P>0.05).However,total bilirubin(TBIL)was 191.8(156.4,227.1)μmol/L in CBA group and 152.5(104.3,200.6)μmol/L in CC group;direct bilirubin(DBIL)66.7(41.0,97.1)μmol/L in CBA group and 47.3(21.8,70.8)μmol/L in CC group;total bile acid(TBA)91.4(62.1,114.8)μmol/L in CBA group and 61.9(17.5,91.1)μmol/L in CC group.The inter-group differences were statistically significant(P<0.05).The areas under the ROC curve for TBIL,DBIL,TBA and wei

关 键 词：胆总管囊肿 囊肿型胆道闭锁 γ-谷氨酰转移酶 天门冬氨酸氨基转移酶 谷丙转氨酶 总胆红素 直接胆红素 总胆汁酸 诊断 鉴别 

分 类 号：G84[文化科学—体育训练]