甲胎蛋白和其他血生化指标构建潜在的胆道闭锁患儿早期诊断模型

Plasma alpha-fetoprotein and other biochemical indicators for constructing early diagnosis models of potential biliary atresia in children

背景:胆道闭锁主要依赖于术中诊断,操作复杂且对待诊患儿的伤害较大,不适合作为早期诊断的方法。因此,寻找简单有效的血液生化诊断指标将改善早期诊断效率。目的:检测胆道闭锁患儿血浆甲胎蛋白水平,探索甲胎蛋白和血液生化指标在胆道闭锁临床诊断中的应用价值。方法:收集48例胆道闭锁患儿、20例肝炎患儿与9名健康婴儿血液样本,采用酶联免疫吸附试验测定患儿血浆中甲胎蛋白质量浓度,分析甲胎蛋白与血生化指标的相关性,建立潜在的诊断模型。试验通过新华医院伦理委员会的批准(批准号:XHEC-D-2013-026)。结果与结论:(1)胆道闭锁组和肝炎组甲胎蛋白质量浓度显著高于健康组(P <0.001),胆道闭锁组和肝炎组甲胎蛋白质量浓度比较差异无显著性意义(P>0.05);(2)48例胆道闭锁患儿中,不同肝纤维分级患儿间的甲胎蛋白质量浓度比较差异无显著性意义(P> 0.05);(3)血液生化指标显示,胆道闭锁组和肝炎组均有严重的肝损伤,两组前白蛋白、γ-谷氨酰胺转肽酶水平比较差异有显著性意义(P<0.05,P<0.001);(4)甲胎蛋白和γ-谷氨酰胺转肽酶水平呈现负相关(r=-0.516,P <0.01);(5)结合甲胎蛋白、前白蛋白、γ-谷氨酰胺转肽酶及患儿年龄和性别建立了一个潜在的诊断模型,敏感性为81.82%,特异性为91.67%,模型的曲线下面积AUC达到0.939;(6)结果说明,胆道闭锁患儿血浆甲胎蛋白水平明显升高,通过甲胎蛋白等生化指标构建的诊断模型对胆道闭锁临床诊断有一定的参考价值。

BACKGROUND: Biliary atresia is not suitable as a method for early diagnosis because it mainly depends on intraoperative diagnosis, and the operation is complicated, and there is a great injury to the child. Therefore, finding simple and effective blood biochemical diagnostic indicators will improve early diagnosis efficiency.OBJECTIVE: To measure the plasma alpha-fetoprotein level in children with biliary atresia and to investigate the application value of plasma alpha-fetoprotein level and blood biochemical indicators.METHODS: Blood samples were harvested from 48 infants with biliary atresia, 20 infants with neonatal hepatitis, and 9 healthy controls.Plasma alpha-fetoprotein level was measured by enzyme-linked immunosorbent assay. The correlation between plasma alpha-fetoprotein level and blood biochemical indicators was analyzed to establish a potential diagnosis model. This study was approved by the Ethics Committee of Xinhua Hospital, China(approval No. XHEC-D-2013-026).RESULTS AND CONCLUSION: Plasma alpha-fetoprotein level in infants with biliary atresia and neonatal hepatitis was significantly higher than that in the healthy controls(P < 0.001), but no significant difference in plasma alpha-fetoprotein level was observed between infants with biliary atresia and neonatal hepatitis(P > 0.05). There was no significant difference in plasma alpha-fetoprotein level between infants with different stages of cirrhosis(P > 0.05). Blood biochemical indexes indicated severe liver injury in infants with biliary atresia and neonatal hepatitis. There were significant differences in plasma prealbumin(P < 0.05) and γ-glutaminyl transpeptidase levels between infants with biliary atresia and neonatal hepatitis(P < 0.01). Plasma alpha-fetoprotein level was negatively correlated with γ-glutaminyl transpeptidase level(r =-0.516, P < 0.01). A potential diagnosis model was established based on plasma alpha-fetoprotein, prealbumin,γ-glutaminyl transpeptidase levels, age and sex of infant patients, with a sensitivity of 81.82%, specificity of 91.67%, and area under the curve of 0.939. Results suggest that plasma alpha-fetoprotein level increased in infants with biliary atresia. Establishing a diagnosis model based on blood biochemical indicators such as plasma alpha-fetoprotein is of certain reference value for clinical diagnosis of biliary atresia.