婴儿胆道闭锁与肝内胆汁淤积症的临床特征分析

Clinical characteristics of biliary atresia and intrahepatic cholestasis in infants

目的:分析婴儿胆道闭锁(BA)与肝内胆汁淤积症(IHC)临床特征的差异,探讨实验室指标对BA早期诊断的价值。方法:回顾分析2015年2月—2020年2月住院的248例BA患儿的临床资料,将其设为观察组,选取同一时期就诊的221例肝内胆汁淤积症患儿作为对照组,观察比较两组患儿一般资料、生化指标及肝胆超声结果的差异,采用二元Logistic回归分析及受试者工作特征(ROC)曲线分析实验室指标在BA早期诊断中的价值。结果:观察组出生体质量高于对照组、黄疸出现时间早于对照组、白陶土样大便所占比例高于对照组,差异均有统计学意义(P<0.01);观察组总胆红素(TBil)、直接胆红素(DBil)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、胆汁酸(TBA)、γ-谷氨酰转肽酶(GGT)、天门冬氨酸氨基转移酶/血小板指数(APRI)水平均显著高于对照组(P<0.01);观察组肝胆超声异常(肝门三角形条索征或胆囊异常)比例明显高于对照组,差异具有统计学意义(P<0.01);二元Logistic回归分析结果显示,TBil,DBil,AST,GGT对BA的诊断有显著影响(P<0.05),将TBil,DBil,AST,GGT及TBil,DBil联合GGT对BA的诊断价值行ROC曲线分析,结果显示,GGT+TBil的ROC曲线下面积(AUC)最大,为0.899(95%CI 0.869~0.928),当GGT取值为194.5 U/L,TBil取值为150.6μmol/L时,其敏感度和特异度分别为94.0%和73.3%,联合诊断价值优于单一指标诊断价值。将两组按照年龄的不同分为≤30 d,31~60 d,61~90 d,91~120 d和≥120 d亚组,分别比较不同年龄组GGT水平差异,结果显示,≤30 d,31~60 d,61~90 d,91~120 d组GGT水平观察组均明显高于对照组(P<0.05);使用ROC曲线分析不同年龄组GGT水平对BA的诊断价值,结果显示,61~90 d组诊断价值最高,AUC为0.905(95%CI 0.852~0.959),GGT取临界值326 U/L,其敏感度和特异度分别为81.9%,91.5%。结论:婴儿胆道闭锁与肝内胆汁淤积症在临床特征、实验室指标、肝胆超声方面存在一定的差异,白陶土样便及TBiL,DBiL,GGT联合肝胆超声综合分析可提高诊断的准确性。

Objective:To analyze the differences in clinical characteristics between infant biliary atresia(BA)and intrahepatic cholestasis(IHC),and to study the value of laboratory indicators for early diagnosis of BA.Methods:The clinical data of 248 children with BA hospitalized in hospital from February 2015 to February 2020 were retrospectively analyzed as the observation group,and 221 children with intrahepatic cholestasis hospitalized in our hospital during the same period were selected as the control group.The differences in general clinical data,biochemical indexes and hepatobiliary ultrasound results between the two groups were observed and compared,binary logistic regression analysis and receiver operator characteristic(ROC)curve were used to analyze the value of laboratory indicators in BA diagnosis.Results:The birth weight of observation group was higher than that of control group,the jaundice appeared earlier than that of control group,and the proportion of clay like stool was higher than that of control group(P<0.01).Total bilirubin(TBil),direct bilirubin(DBil),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bile acid(TBA),the levels ofγ-glutamyl transpeptidase(GGT)and aspartate aminotransferase/platelet index(APRI)were significantly higher than those in control group(P<0.01).The proportion of abnormal liver and gallbladder of ultrasound(hepatic hilus triangle or gallbladder malformation)in observation group was significantly higher than that in control group(P<0.01).The results of binary logistic regression analysis showed that TBil,DBil,AST and GGT had a significant impact on the diagnosis of BA(P<0.05).The ROC curve analysis of TBil,DBil,AST,GGT and the diagnostic value of TBil,DBil and GGT for BA showed that the AUC of GGT and TBil was the largest,0.899(95%CI 0.869~0.928).When the value of GGT was 194.5 U/L and the value of TBil was 150.6μmol/L,the sensitivity and specificity were 94.0%and 73.3%respectively.The value of combined diagnosis was better than that of single index.The two groups were divided into groups≤30 d,31~60 d,61~90 d,91~120 d and≥120 d according to their ages.The GGT levels of the groups≤30 d,31~60 d,61~90 d and 91~120 d were significantly higher in BA group than in IHC group(P<0.05).ROC curve was used to analyze the diagnostic value of GGT level in different age groups for BA.The results showed that the diagnostic value of 61~90 d group was the highest,with AUC of 0.905(95%CI 0.852~0.959).The critical value of GGT was 326 U/L,and its sensitivity and specificity were 81.9%and 91.5%respectively.Conclusion:There are certain differences between infant biliary atresia and intrahepatic cholestasis in clinical features,laboratory indicators and hepatobiliary ultrasound.The comprehensive analysis of white stool,TBil,DBil,GGT and hepatobiliary ultrasound can improve the accuracy of diagnosis.