PIVKA-Ⅱ对胆道闭锁的诊断价值及其与肝功能的相关性研究

Diagnostic value of PIVKA-Ⅱ for biliary aresia and its correlations with liver functions

目的初步探讨PIVKA-Ⅱ对胆道闭锁的诊断价值及其与肝功能各项指标间的相关性。方法以复旦大学附属儿科医院2016年7月至2017年3月收治的131例因梗阻性黄疸入院且术中诊断为胆道闭锁的患儿为研究对象。选取排除胆道闭锁的胆汁淤积症患儿及同年龄段行臂丛神经损伤修复手术且肝功能正常的患儿作为对照组,测定各组的血清PIVKA-Ⅱ含量并进行统计分析。结果3组患儿PIVKA-Ⅱ水平分别为:胆道闭锁组29. 39 (19. 29～173. 80) m AU/m L;胆汁淤积组22. 59(18. 20～38. 34) m AU/m L;肝功能正常组24. 77(21. 01～29. 20) m AU/m L。胆道闭锁组患儿血清PIVKA-Ⅱ含量比其他两组更高(P <0. 05); PIVKA-Ⅱ在对胆道闭锁及胆汁淤积进行鉴别诊断时,敏感性与特异性分别为97. 67%和35. 11%; PIVKA-Ⅱ含量在不同性别组中比较无统计学差异(P> 0. 05);各年龄段胆道闭锁患儿PIVKA-Ⅱ水平无统计学差异(P> 0. 05); PIVKA-Ⅱ与γ-谷氨酰转移酶、胆红素、肝功能、白蛋白之间无统计学相关性(P> 0. 05); PIVKA-Ⅱ与各凝血功能指标之间亦无统计学相关性(P>0. 05)。结论梗阻性黄疸患儿普遍存在PIVKA-Ⅱ水平异常,其中胆道闭锁患儿PIVKA-Ⅱ水平升高更为显著,有一定鉴别意义,或可将PIVKA-Ⅱ作为术前诊断胆道闭锁的参考指标。

Objective To explore the diagnostic value of PIVKA-Ⅱ for biliary aresia （BA） and its correlation with liver functions. Methods From July 2016 to March 2017,a total of 131 patients with obstructivejaundice were collected. Basic profiles and preoperative serum were collected for testing the value of PIVKA-Ⅱ.Results The level of PIVKA-Ⅱwas 29. 39 （19. 29 ～ 173. 80） mAU/ mL in BA group,22. 59 （18. 20 ～ 38. 34）mAU/ mL in cholestasis group and 24. 77（21. 01 ～ 29. 20） mAU/ mL in normal liver function group. Significantdifferences existed among three groups. And the serum level of PIVKA-Ⅱ in BA children was higher than thatof another two groups （P 〈 0. 05）. In the differential diagnosis of PIVKA-Ⅱ between groups of BA and cholestasis,the sensitivity and specificity of diagnosing were 97. 67% and 35. 11% respectively. No significant difference existed in PIVKA-Ⅱ level between boys and girls with BA（P 〉 0. 05）. And no significant difference existed in PIVKA-Ⅱ level among BA children of all ages（P 〉 0. 05）. PIVKA-Ⅱ and gammaglutamyl transferase,bilirubin,liver function,albumin showed no correlation（P 〉 0. 05）. No statistically significant correlation existed between PIVKA-Ⅱ and coagulatory function. Conclusion BA Children with obstructive jaundice haswidespread anomalies of PIVKA-Ⅱ level. It may be used as a reference index of preoperative diagnosis of BA.