放射性核素肝胆显像联合总胆汁酸、谷氨酰转肽酶检测对婴儿持续性黄疸的诊断价值

Value of hepatobiliary scintigraphy combined with total bile acid and γ-glutamyltransferase detection in etiological diagnosis of the persistent jaundice in infants

目的 研究放射性核素肝胆显像联合总胆汁酸（TBA）、谷氨酰转肽酶（γ-GT）测定对临床难以鉴别的婴儿肝炎综合征（IHS）与先天性肝外胆管闭锁（EHBA）所导致的婴儿持续性黄疸的诊断价值.方法 回顾性分析南方医院60例持续性黄疸患儿的病例资料,均采用单光子发射计算机断层成像仪（SPECT）进行99Tcm-二乙基乙酰苯胺亚氨二醋酸（EHIDA）肝胆显像,同时AU5431全自动生化分析仪检测其血生化水平,分析99Tcm-EHIDA肝胆显像及联合TBA、γ-GT检测的诊断效能.结果 99Tcm-EHIDA显像诊断EHBA灵敏度、特异性和准确度分别为100.00％（17/17例）、67.57％（25/37例）和77.78％（42/54例）,而诊断IHS灵敏度、特异性和准确度分别为67.57％（25/37例）、100.00％（17/17例）和77.78％（42/54例）.其中在EHBA组与IHS组间血清TBA、γ-GT水平的差异有统计学意义（U=209.0、19.5,P均＜0.05）;受试者工作特征（ROC）曲线分析示TBA在IHS组,γ-GT在EHBA组有一定的诊断价值（ROC曲线下面积分别为0.736、0.968）.99Tcm-EHIDA肝胆显像联合TBA、γ-GT分析表明,放射性核素肝胆显像显示肠道无放射性显影,γ-GT为298 U/L,TBA为98.5 μmol/L时,诊断EHBA系列试验的灵敏度、特异性和准确度分别为100.00％（17/17例）、100.00％（37/37例）和100.00％（54/54例）.结论 99Tcm-EHIDA肝胆显像联合TBA、γ-GT检测可早期、无创、安全、有效地鉴别EHBA与IHS,对于婴儿持续性黄疸进一步治疗具有重要指导意义.

Objective To investigate the value of hepatobiliary scintigraphy combined with total bile acid （TBA） and γ-glutamyhransferase（γ-GT） detection in the differential diagnosis of persistent jaundice induced by infantile hepatitis syndrome（IHS） and congenital extrahepatic biliary atresia（EHBA）.Methods A retrospective analysis of 60 infants with persistent jaundice undertaking 99Tcm-diethylacetanilide iminodiacetic acid （EHIDA） hepatobiliary scintigraphy was done in Nanfang Hospital by single photon emission computed tomography（SPECT）.Meanwhile,these infants＇sera were collected and separately detected by AU5431 automatic biochemical assay;the sensitivity,specificity and accuracy of hepatobiliary scintigraphy with TBA and γ-GT were evaluated.Results The sensitivity to 99Tcm-EHIDA hepatobiliary scintigraphy in the diagnosis of HIS and EHBA were 100.00% （17/17 cases） and 67.57% （25/37 cases）,the specificity was 67.57% （25/37 cases） and 100.00% （17/17 cases）,and the accuracy was 77.78% （42/54cases） and 77.78% （42/54 cases）,respectively.The levels of TBA and γ-GT were higher in infants with EHBA than those with HIS（U =209.0,19.5,all P 〈0.05）,and ROC curve analysis indicated that TBA in the HIS group and γ-GT in EHBA group had some diagnostic value[area under curve （AUC） =0.736,0.968,respectively].99Tcm-EHIDA hepatobiliary scintigraphy combined with TBA and γ-GT analysis suggested when intestinal non-radioactive imaging was shown,TBA was 98.5 μmol/L and γ-GT was 298 U/L,the sensitivity,specificity and accuracy of diagnosis of EHBA were 100.00.00% （17/17 cases）,100.00% （37/37 cases） and 100.00% （54/54 cases） in a serial test.Conclusions Hepatobiliary scintigraphy combined with TBA and γ-GT examination can effectively identify EHBA and HIS earlier,noninvasively and safely,which have important role in further treatment in infants with persistent jaundice.