新生儿胆道闭锁的预警筛查与早期诊断

Early Detection and Diagnosis of Biliary Atresia in Neonates

胆道闭锁是婴儿期的严重慢性肝病,表现为破坏性炎性阻塞性胆管病。近期研究显示对30 d内胆道闭锁患儿实施早期Kasai手术最有可能延缓或防止肝移植,但目前国内外Kasai手术时间多在60 d左右,主要原因在于早期诊断面临很多困难和挑战,如30 d前行γ-谷氨酰基转肽酶筛查要充分考虑年龄分层的因素,且胆道系统早期病变程度轻微,导致影像学检查(如超声)的准确度降低,给精准医疗和改善预后带来挑战。本文对胆道闭锁新生儿早期诊断方式进行综述,旨在为30 d内的早期识别提供参考,并对未来潜在发展前景和研究方向进行分析。

Biliary atresia is a severe chronic liver disease in infancy that manifests as destructive inflammatory obstructive cholangiopathy.Recent evidence supports that early Kasai procedure by 30 days of life achieves the greatest likelihood of slowing or preventing the need for liver transplant in biliary atresia patients.Unfortunately,the average age at the time of Kasai procedure is around 60 days of life both in China and abroad.The primary reason for this is that there are many difficulties and challenges in early diagnosis.For example,age stratification should be considered when using GGT levels as a screening tool for biliary atresia in infant less than 30 days.What's more,imaging modality such as US shows lower accuracy in very early stage due to milder pathological change in biliary tract,which post challenges on precision medicine and improving prognosis.This article reviewed different early diagnostic methods of screening for biliary atresia,so as to provide a reference for the early diagnosis of biliary atresia,and help discuss the potential development prospect and research direction in the future.