血清总胆汁酸联合γ谷氨酰转肽酶检测在评估延迟性黄疸病因中的价值

Value of serum total bile acid and γ-glutamyl-transferase in etiological diagnosis of prolonged jaundice

目的探讨总胆汁酸联合γ谷氨酰转肽酶(γ-GT)检测在鉴别延迟性黄疸的病因及判断预后中的作用。方法 95例延迟性黄疸患儿根据胆红素水平分为婴儿肝炎综合征组(n=35)、胆道闭锁组(n=30)和间接胆红素升高组(n=30),选取相同年龄段无黄疸及肝功能损害的住院患儿作为对照组(n=30),分别于治疗前后检测肝功能指标,经受试者工作特征(ROC)曲线评价总胆汁酸联合γ-GT测定的诊断价值,分析治疗后患者各项肝功能指标变化的相关性。结果胆道闭锁组γ-GT水平显著高于其他各组(P<0.01),婴儿肝炎组和胆道闭锁组总胆汁酸水平显著高于间接胆红素升高组和正常对照组(P<0.05)。ROC曲线分析提示,总胆汁酸水平对婴儿肝炎综合征组和胆道闭锁组的诊断价值较低,γ-GT水平对胆道闭锁组有一定的诊断价值,当总胆汁酸为88.35μmol/L、γ-GT为250.5 U/L时,诊断胆道闭锁平行试验的灵敏度为97.9%,串联试验的特异度为90.5%。相关性分析结果显示:治疗后婴儿肝炎综合征组总胆红素变化与直接胆红素、谷丙转氨酶和总胆汁酸有关。结论在以间接胆红素升高为主的延迟性黄疸患者,总胆汁酸和γ-GT均无明显升高,预后良好。在以直接胆红素升高为主的延迟性黄疸患者,总胆汁酸与γ-GT均明显升高,倾向于胆道闭锁的诊断;总胆汁酸显著升高而γ-GT升高不明显,则倾向于婴儿肝炎综合征的诊断。

Objective To determine the value of serum total bile acid and γ- glutamyl-transferase （γ-GT） in the determination of etiology and prediction of prognosis of prolonged jaundice. Methods Ninety-five infants with prolonged jaundice were divided into infantile hepatitis syndrome group （ n = 35） , biliary atresia group （ n = 30） and elevated indirect bilirubin group （ n = 30） according to the bilirubin levels. Besides, 30 age-matched hospitalized infants without jaundice and liver function injury were served as controls. The liver function parameters were measured before and after treatment, the diagnosis value of serum total bile acid and γ-GT was determined with receiver operator characteristic （ROC） curve, and the correlation of liver function parameters after treatment was analysed. Results The serum γ-GT level in biliary atresia group was significantly higher than those in the other groups （ P 〈 0.01）, and the serum total bile acid levels in infantile hepatitis syndrome group and biliary atresia group were significantly higher than those in elevated indirect bilirubin group and control group （ P 〈 0.05） . ROC curve analysis indicated that serum total bile acid had lower diagnostic efficiency for infantile hepatitis syndrome and biliary atresia, and γ-GT had definite diagnostic value for biliary atresia. When serum total bile acid level was 88.35 μmol/L and γ-GT was 250.5 U/L, the sensitivity of diagnosis of biliary atresia was 97.9% in a parallel trial, and the specificity was 90. 5% in a serial test. Con＇elation analysis revealed that the changes of serum bilirubin were related to direct bilinlbin, alanine aminotransferase and bile acid in infantile hepatitis syndrome group. Conclusion In the prolonged jaundice with an elevated indirect bilirubin, total bile acid and γ-GT are not significantly elevated, and the prognosis is favorable. In the prolonged jaundice with an elevated direct bilirubin, when total bile acid and γ-GT are significantly elevated, the diagnosis may tend to be biliary atresia. In the prolonged jaundice with an elevated direct bilimbin,when total bile acid is significantly increased, while γ-GT is not, the diagnosis may tend to be infantile hepatitis syndrome.