先天性胆道闭锁患儿围术期血清总胆红素对脂溶性维生素缺乏的预测价值分析

Value of perioperative serum total bilirubin of children with congenital biliary atresia predicting fat-soluble vitamin deficiency

目的探讨先天性胆道闭锁(CBA)患儿围术期血清总胆红素(TB)对脂溶性维生素缺乏的预测价值。方法选择2008年1月至2014年6月期间我院收治的CBA患儿72例作为观察组,另选取30同期健康出生婴儿作为对照组。观察组均接受相应的手术治疗和脂溶性维生素补充,检测对照组和观察组术前、术后1 d、3 d、6 d、12 d、1个月、3个月和6个月的血清TB和胆汁酸(SBA)水平及维生素A、维生素D、维生素E及维生素K等脂溶性维生素水平,分析患儿血清TB和SBA水平与其脂溶性维生素水平的关系和患儿血清总TB和SBA水平预测其脂溶性维生素缺乏的价值。结果观察组术前血清TB和SBA水平均高于对照组(P<0.05);且观察组术后6 d后血清TB和SBA水平均低于术前,差异有统计学意义(P<0.05)。与对照组比较,观察组围术期血清脂溶性维生素水平均降低;与术前比较,观察组后1个月后的清脂溶性维生素水平均升高,差异有统计学意义(P<0.05)。CBA患儿血清TB和SBA水平与其血清脂溶性维生素水平均呈负相关P<0.05)。ROC曲线分析结果显示,TB预测CBA患儿脂溶性维生素缺乏的曲线下面积、灵敏度和准确性均较高且均高于SBA预测CBA患儿脂溶性维生素缺乏(P<0.05)。结论 CBA患儿围术期血清TB水平较高且其预测患儿脂溶性维生素缺乏的价值良好,血清TB可作为CBA患儿脂溶性维生素缺乏情况评估和治疗的参考指标。

Objective To explore the Value of perioperative serum total bilirubin （TB） of children with congenital biliary atresia （CBA） predicting fat-soluble vitamin deficiency. Methods Seventy- two CBA babies in our hospital from January 2008 to June 2014 were selected as observation group, and 30 health babies in our hospital in the same period were selected as control group. The patients in observation group accepted surgical treatment and fat-soluble vitamin supplement. Serum levels of TB and bile acid （SBA）, vitamin A, vitamin D, vitamin E, vitamin K in preoperative and postoperative 1 d, 3 d, 6 d, 12 d, 1 month, 3 months and 6 months were detected. Relationship between serum TB and SBA in CBA children and fat-soluble vitamin levels were analyzed, and value of serum TB and SBA level predicting fat-soluble vitamin deficiency was also analyzed. Results Preoperative and postoperative serum TB and SBA level of observation group higher than that of the control group （P〈 0.05）. And postoperative 6 d or later serum TB and SBA levels of the observation group were lower than that of preoperative; And the difference was statistically significant （P〈0.05）. Compared with control group, perioperative serum fat-soluble vitamins level of observation group were lower; Compared with preoperative, postoperative one month or later serum fat-soluble vitamins level of observation group were increased. And the difference was statistically significant （P〈0.05）. Pearson correlation analysis results showed that the levels of serum TB and SBA in CBA babies were negativelycorrelated with serum fat-soluble vitamins level（P〈0.05）. ROC curve analysis results showed the area under the curve, sensitivity and accuracy of serum rib level of CBA infants predicting fat-soluble vitamin deficiency were higher than that of serum SBA level of CBA infants predicting fat-soluble vitamin deficiency （P〈0.05）. Conclusion Perioperative serum TB levels of CBA infants is high and the value of serum TB levels predicting fat-soluble vitamin deficiency is good. Serum TB can be used as reference in fat-soluble vitamin lack assessment of CBA infants and their treatment.