PDF(1284 KB)
血清γ-谷氨酰转肽酶联合直接胆红素诊断婴儿胆道闭锁的价值
付海燕, 赵瑞芹, 白革兰, 殷春兰, 殷润开, 李海花, 石伟娜, 刘亚丽, 程丽娟, 贾霄云, 李桂桂, 赵世光
中国当代儿科杂志 ›› 2019, Vol. 21 ›› Issue (12) : 1198-1202.
PDF(1284 KB)
PDF(1284 KB)
血清γ-谷氨酰转肽酶联合直接胆红素诊断婴儿胆道闭锁的价值
Value of serum gamma-glutamyl transpeptidase combined with direct bilirubin in the diagnosis of biliary atresia in infants
目的 探讨血清γ-谷氨酰转肽酶（GGT）联合直接胆红素（DB）对胆道闭锁的诊断价值。方法 选取2010年7月至2018年12月住院治疗的胆汁淤积症患儿667例为研究对象，根据术中胆管造影结果和随访情况，将患儿分为胆道闭锁组（n=234）和胆汁淤积组（n=433）。比较两组的发病年龄、性别，以及血清总胆红素（TB）、DB、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆汁酸（TBA）、GGT水平。将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 胆道闭锁组患儿发病年龄早于胆汁淤积组（P < 0.001）。两组患儿性别、ALT及AST水平比较差异无统计学意义（P > 0.05）。胆道闭锁组TB、DB、TBA、GGT水平显著高于胆汁淤积组（P < 0.05）。GGT联合DB诊断胆道闭锁的AUC最大，为0.892（95% CI：0.868~0.916）。当GGT取值为324.0 U/L，DB取值为115.1 μmol/L时，GGT与DB联合诊断胆道闭锁的敏感度和特异度分别为79.8%、83.2%。结论 GGT联合DB诊断胆道闭锁的敏感度和特异度较高，可作为诊断胆道闭锁的有效指标之一。
Objective To study the value of serum gamma-glutamyl transpeptidase (GGT) combined with direct bilirubin (DB) in the diagnosis of biliary atresia. Methods A total of 667 infants with cholestasis who were hospitalized and treated from July 2010 to December 2018 were enrolled as subjects. According to the results of intraoperative cholangiography and follow-up, they were divided into biliary atresia group with 234 infants and cholestasis group with 433 infants. The two groups were compared in terms of age of onset, sex, and serum levels of total bilirubin (TB), DB, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bile acid (TBA), and GGT. A receiver operating characteristic (ROC) curve analysis was performed for indices with statistical significance, and the area under the ROC curve (AUC) and the optimal cut-off value for diagnosis were calculated. Results The biliary atresia group had a significantly younger age of onset than the cholestasis group (P < 0.001). There were no significant differences in sex, ALT, and AST between the two groups (P > 0.05), while the biliary atresia group had significantly higher serum levels of TB, DB, TBA, and GGT than the cholestasis group (P < 0.05). GGT combined with DB had the highest AUC of 0.892 (95% confidence interval:0.868-0.916) in the diagnosis of biliary atresia. At the optimal cut-off values of 324.0 U/L for GGT and 115.1 μmmol/L for DB, GGT combined with DB had a sensitivity of 79.8% and a specificity of 83.2% in the diagnosis of biliary atresia. Conclusions GGT combined with DB has high sensitivity and specificity in the diagnosis of biliary atresia and can be used as an effective indicator for diagnosis of biliary atresia in infants.
Biliary atresia / Gamma-glutamyl transpeptidase / Direct bilirubin / Infant
[1] Schreiber RA, Barker CC, Roberts EA, et al. Biliary atresia:the Canadian experience[J]. J Pediatr, 2007, 151(6):659-665.
[2] Superina R. Biliary atresia and liver transplantation:results and thoughts for primary liver transplantation in select patients[J]. Pediatr Surg Int, 2017, 33(12):1297-1304.
[3] Kasahara M, Umeshita K, Sakamoto S, et al. Liver transplantation for biliary atresia:a systematic review[J]. Pediatr Surg Int, 2017, 33(12):1289-1295.
[4] Chen X, Dong R, Shen Z, et al. Value of gamma-glutamyl transpeptidase for diagnosis of biliary atresia by correlation with age[J]. J Pediatr Gastroenterol Nutr, 2016, 63(3):370-373.
[5] Hayashida M, Matsuura T, Kinoshita Y, et al. Parameters that help to differentiate biliary atresia from other diseases[J]. Pediatr Int, 2017, 59(12):1261-1265.
[6] Sun S, Chen G, Zheng S, et al. Analysis of clinical parameters that contribute to the misdiagnosis of biliary atresia[J]. J Pediatr Surg, 2013, 48(7):1490-1494.
[7] Dong C, Zhu HY, Chen YC, et al. Clinical assessment of differential diagnostic methods in infants with cholestasis due to biliary atresia or non-biliary atresia[J]. Curr Med Sci, 2018, 38(1):137-143.
[8] Liu X, Peng X, Huang Y, et al. Design and validation of a noninvasive diagnostic criteria for biliary atresia in infants based on the STROBE compliant[J]. Medicine (Baltimore), 2019, 98(6):e13837.
[9] A??n M, Tümgör G, Alkan M, et al. Clues to the diagnosis of biliary atresia in neonatal cholestasis[J]. Turk J Gastroenterol, 2016, 27(1):37-41.
[10] Nakamura H, Yamataka A. Non-invasive and accurate diagnostic system for biliary atresia[J]. EBioMedicine, 2018, 36:16-17.
[11] Dong R, Jiang J, Zhang S, et al. Development and validation of novel diagnostic models for biliary atresia in a large cohort of Chinese patients[J]. EBioMedicine, 2018, 34:223-230.
[12] Moyer V, Freese DK, Whitington PF, et al. Guideline for the evaluation of cholestatic jaundice in infants:recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition[J]. J Pediatr Gastroenterol Nutr, 2004, 39(2):115-128.
[13] Chardot C, Buet C, Serinet MO, et al. Improving outcomes of biliary atresia:french national series 1986-2009[J]. J Hepatol, 2013, 58(6):1209-1217.
[14] Chiu CY, Chen PH, Chan CF, et al. Biliary atresia in preterm infants in Taiwan:a nationwide survey[J]. J Pediatr, 2013, 163(1):100-103.e1.
[15] Serinet MO, Wildhaber BE, Broué P, et al. Impact of age at Kasai operation on its results in late childhood and adolescence:a rational basis for biliary atresia screening[J]. Pediatrics, 2009, 123(5):1280-1286.
[16] Fawaz R, Baumann U, Ekong U, et al. Guideline for the evaluation of cholestatic jaundice in infants:joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition[J]. J Pediatr Gastroenterol Nutr, 2017, 64(1):154-168.
[17] Harpavat S, Finegold MJ, Karpen SJ. Patients with biliary atresia have elevated direct/conjugated bilirubin levels shortly after birth[J]. Pediatrics, 2011, 128(6):e1428-e1433.
[18] Harpavat S, Ramraj R, Finegold MJ, et al. Newborn direct or conjugated bilirubin measurements as a potential screen for biliary atresia[J]. J Pediatr Gastroenterol Nutr, 2016, 62(6):799-803.
[19] Tang KS, Huang LT, Huang YH, et al. Gamma-glutamyl transferase in the diagnosis of biliary atresia[J]. Acta Paediatr Taiwan, 2007, 48(4):196-200.
[20] El-Guindi MA, Sira MM, Sira AM, et al. Design and validation of a diagnostic score for biliary atresia[J]. J Hepatol, 2014, 61(1):116-123.
[21] Cabrera-Abreu JC, Green A. Gamma-glutamyltransferase:value of its measurement in paediatrics[J]. Ann Clin Biochem, 2002, 39(Pt 1):22-25.
