婴幼儿胆道闭锁与肝内胆汁淤积症的临床特征比较

Comparative analysis of clinical characteristics between biliary atresia and intrahepatic cholestasis in infants

目的比较婴幼儿胆道闭锁(BA)与肝内胆汁淤积症(IHC)的临床特征,为临床诊疗提供指导。方法选择2015年1月至2018年1月间深圳市儿童医院小儿外科诊治的40例胆道闭锁患儿为BA组,40例肝内胆汁淤积症患儿为IHC组。比较两组患儿的一般临床资料、影像学检查及实验室检查资料,ROC曲线分析总胆红素(TBil)、谷丙转氨酶(ALT)、谷氨酰转肽酶(GGT)、谷草转氨酶(AST)、直接胆红素(DBil)对IHC及BA的鉴别诊断价值。结果白便(77.5%vs 17.5%)、肝大(87.5%vs 57.5%)、脾大(37.5%vs 12.5%)比例比较,BA组明显高于IHC组,差异均有统计学意义(P<0.05):超声肝门部纤维斑块样回声(80.0%vs 10.0%)、胆囊异常(77.5%vs 25.0%)比较,BA组明显高于IHC组,差异均有统计学意义(P<0.05);TBil[(198.3±62.5)mmol/L vs(106.5±36.5)mmol/L]、ALT[(228.8±77.9)U/L vs(156.5±55.6)U/L]、GGT[(615.2±265.3)U/L vs(264.5±103.5)U/L]、AST[(338.3±153.5)U/L vs(176.5±88.5)U/L]、DBil[(153.2±57.5)mmol/L vs(88.5±32.6)mmol/L]水平比较,BA组明显高于IHC组,差异均有统计学意义(P<0.05);在IHC及BA鉴别诊断中,TBil线下面积、敏感性及准确度最高,分别为0.850、92.8%和86.6%,GGT特异度最高,为87.6%。结论 BA与IHC的临床特征、影像学检查及实验室检查具有一定的差异,影像学检查及实验室检查有助于鉴别诊断。

Objective To compare the clinical characteristics of biliary atresia and intrahepatic cholestasis in infants, so as to provide guidance for clinical diagnosis and treatment. Methods Forty children with biliary atresia in Department of Pediatric Surgery, Shenzhen children＇s Hospital from Jan. 2015 to Jan. 2018 were selected as BA group,and 40 children of intrahepatic cholestasis were selected as IHC group. The general clinical data, imaging examination and laboratory examination data of the two groups were analyzed and compared. The ROC curve was used to analyze the clinical value of total bilirubin（TBil）, alanine transaminase（ALT）, glutamyl transaminopeptidase（GGT）, glutamine transaminase（AST） and direct cholesterol（DBil） in the differential diagnosis of IHC and BA. Results The proportions of white stool, hepatomegaly, splenomegaly were 77.5%, 87.5%, 37.5% in BA group versus 17.5%, 57.5%, 12.5% in IHC（P〈0.05）. The proportion of fibrous plaque-like echo, gallbladder abnormality were 80.0%, 77.5% in BA group versus 10.0%, 25.0% in IHC group（P〈0.05）. The levels of TBil, ALT, GGT, AST, DBil were（198.3±62.5） mmol/L,（228.8±77.9） U/L,（615.2 ± 265.3） U/L,（338.3 ± 153.5） U/L,（153.2 ± 57.5） mmol/L in BA group versus（106.5 ± 36.5） mmol/L,（156.5±55.6） U/L,（264.5±103.5） U/L,（176.5±88.5） U/L,（88.5±32.6） mmol/L in IHC group（P〈0.05）. In the differential diagnosis of IHC and BA, the ROC, sensitivity and accuracy of TBil were the highest, which were 0.850, 92.8% and86.6%, respectively, and the specificity of GGT was the highest（87.6%）. Conclusion There are some differences between BA and IHC in clinical characteristics, imaging examination and laboratory examination, and the imaging and laboratory examination are helpful for differential diagnosis.