胆汁成分检测对婴儿胆汁淤积诊断与鉴别诊断的意义

Detection of bile composition in diagnosis and differential diagnosis of infant cholestasis

婴儿胆汁淤积是多病因多病原引起胆汁流量的减少或缺乏,临床主要表现为高结合胆红素血症、胆汁酸浓度增加、肝脏肿大、质地异常和粪便颜色改变。临床常见原因是淤阻型婴儿肝炎综合征(IHS)与先天性肝外胆道闭锁(EHBA)。依据肝细胞形成的胆汁通过胆道排入十二指肠内原理,应用十二指肠引流管收集胆汁,观察有无胆汁颜色,定量测定胆红素、胆汁酸、γ-谷氨酰转肽酶(γ-GT)值等以进行鉴别诊断。动态十二指肠液检查有胆汁成分者诊断为淤阻型IHS;若动态十二指肠液观察无胆汁成分时,应联合其他鉴别诊断方法进行评估。

Infant cholestasis is reduction or lack of bile flow caused by many etiology and pathogenesis. The main clinical manifestations are hyperbilirubinemia, increased bile acid concentration, hepatomegaly, abnormal texture, and stool color changes. The major reasons are obstructive infant hepatitis syndrome （IHS） and congenital extrahepatic biliary atresia （EHBA）. Because the bile produced by liver cells flows into the duodenum through bile duct, duodenal drainage tube is used to collect bile. Observing the changes of bile color, quantitatively determining the bilirubin, bile acid, glutamyltranspeptidase （γ-GT） and so on contribute to the differential diagnosis. Obstructive HIS can be confirmed if bile composition is found in dynamic examination of duodenal fluid.