实用医学杂志 ›› 2021, Vol. 37 ›› Issue (12): 1607-1612.doi: 10.3969/j.issn.1006⁃5725.2021.12.019

• 医学检查与临床诊断 • 上一篇    下一篇

肝功能相关指标诊断婴儿胆道闭锁的价值

殷润开,赵瑞芹, 付海燕, 白革兰, 李海花,殷春兰, 石伟娜, 刘亚丽, 程丽娟, 贾霄云, 李桂桂, 赵世光, 李晓雷    

  1. 河北省儿童医院消化科(石家庄 050031)

  • 出版日期:2021-06-25 发布日期:2021-06-25
  • 通讯作者: 赵瑞芹 E⁃mail:runkaiy0311@ sina.com
  • 基金资助:

    河北省重点研发计划项目(健康医疗与生物医药专项)(编号:18277726D


     

Value of liver function index in the diagnosis of biliary atresia in infants 

YIN RunkaiZHAO RuiqinFU HaiyanBAI GelanLI HaihuaYIN ChunlanSHI WeinaLIU YaliCHENG LijuanJIA XiaoyunLI Guigui ZHAO ShiguangLI Xiaolei.    

  1. Department of Digestive Diseases,Hebei Children′ s Hospital,Shijiazhuang 050031 China 

  • Online:2021-06-25 Published:2021-06-25
  • Contact: ZHAO Ruiqin E⁃mail:runkaiy0311@sina.com

摘要:

目的 探讨血γ⁃谷氨酰转肽酶(GGT)、直接胆红素(DB)、总胆汁酸(TBA)、谷丙转氨酶 ALT)对婴儿胆道闭锁(BA)的诊断价值。方法 选取 2013 1 月至 2020 1 月住院治疗的胆汁淤积症 患儿 544 例作为研究对象。根据胆道造影结果将患儿分为 BA 组(n = 268)和非 BA 胆汁淤积组(n = 276), 然后对每组患儿根据月龄再次分为 1 ~ 2 月龄组、2 ~ 3 月龄组和≥ 3 月龄组。分别比较 BA 组和非 BA 胆汁 淤积组,以及各月龄组 BA 组和非 BA 胆汁淤积组 GGT、DB、TBA、ALT 水平。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。结果 胆汁淤积的 发病年龄 BA 组早于非 BA 组(P<0.05),两组间性别比较差异无统计学意义(P>0.05);各月龄组中两组 间性别比较差异均无统计学意义(P>0.05);BA DB、ALT、TBA、GGT 水平均明显高于非 BA 胆汁淤积组 P<0.001);GGT AUC 最大,为 0.828(95%CI:0.794 ~ 0.863),当 GGT 取值 276 U/L 时,诊断 BA 的敏感度 和特异度分别为 70.8%、80.1%;1 ~ 2 月龄组和 2 ~ 3 月龄组中均 GGT AUC 最大,分别为 0.857(95%CI 0.804 ~ 0.910)、0.883(95%CI:0.828 ~ 0.939),诊断界值分别为194 U/L、340 U/L;≥ 3月龄组DB的AUC最大,为 0.758(95%CI:0.674 ~ 0.841);当 DB 取值 112.45 μmmol/L 时,诊断 BA 的敏感度和特异度分别为 81.3% 64.8%。结论 GGT DB BA 均具有良好的诊断价值;GGT 1 ~ 3 月龄 BA 患儿具有良好诊断价值;对 ≥ 3月龄BA 患儿,DB 具有更好的诊断意义。

关键词:

胆道闭锁, γ?谷氨酰转肽酶, 直接胆红素, 总胆汁酸, 谷丙转氨酶

Abstract:

Objective To investigate the value of serum γ⁃glutamyl transpeptidase(GGT),direct biliru⁃ bin(DB),total bile acid(TBA)and alanine amino transferase(ALT)in the diagnosis of biliary atresia(BA). Methods A total of 544 infants with cholestasis who were hospitalized and received treatment from January 2013 to January 2020 were enrolled in this study. According to the results of intraoperative cholangiography,they were divided into BA group with 268 infants and non⁃BA cholestasis group with 276 infants. Serum levels of GGT,DB TBA and ALT were compared between the two groups. According to the age,infants were divided into 1 ~ 2 month group,2 ~ 3 month group and over 3 month group,and the four indexes were also analyzed among 3 group. A receiver operating characteristic(ROC)curve analysis was performed for indexes with statistical significance,and the area under the ROC curve(AUC)and the optimal cut ⁃off value for diagnosis were calculated. Results The BA group had a younger age of onset than that in the non⁃BA cholestasis group(P<0.05). There was no signifi⁃ cant difference in sex between the two groups,while the BA group had significantly higher serum levels of GGT DB,TBA and ALT than those in the non⁃BA cholestasis group(P<0.001). GGT had the highest AUC of 0.828 (95% CI:0.794 ~ 0.863)in the diagnosis of BA,and at the optimal cut⁃off value of 276U/L it had a sensitivity of 70.8% and a specificity of 80.1%. GGT also had the highest AUC in the 1 ~ 2 month group(AUC = 0.857,95% CI 0.804 ~ 0.910)and 2 ~ 3 month group(AUC = 0.883,95% CI:0.828 ~ 0.939)with the cut⁃off values of 194 U/L 340 U/L. DB had the highest AUC of 0.758(95% CI:0.674 ~ 0.841)in the over 3 month group,and at the opti⁃ mal cut⁃off value of 112.45 μmmol/L,it had a sensitivity of 81.3% and a specificity of 64.8%. Conclusions Both GGT and DB had good diagnostic value for BA. GGT had good diagnostic value for children aged 1~3⁃month partic⁃ ularly,while DB had better diagnostic value for children aged over 3 months. 

Key words:

biliary atresia, γ?glutamyl transpeptidase, direct bilirubin, total bile acid, alanine amino transferase