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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

28卷

期数:

2022年05期

页码:

472-477

栏目:

肝胆疾病专题

出版日期:

2022-09-20

文章信息/Info

Title:

Diagnostic value and clinical significance of blood ALP，GGT and TBA in biliary atresia

文章编号:

1006-8147(2022)05-0472-06

作者:

张瑞丰¹; 2; 李腾飞¹; 刘邵文¹; 张树建²; 马慧³; 詹江华²; 4

（1.天津医科大学研究生院，天津300070；2.天津市儿童医院普通外科，天津300134；3.天津市儿童医院检验科，天津300134；4.天津市儿童医院儿研所，天津300134）

Author(s):

ZHANG Rui-feng¹; 2; LI Teng-fei³; LIU Shao-wen³; ZHANG Shu-jian²; MA Hui⁴; ZHAN Jiang-hua²; 5

（1.Graduate School，Tianjin Medical University，Tianjin 300070，China； 2. Department of General Surgery，Tianjin Children′s Hospital，Tianjin 300134，China；3.Department of Laboratory，Tianjin Children′s Hospital，Tianjin 300134，China；4.Children′s Institute，Tianjin Children′s Hospital，Tianjin 300134，China）

关键词:

胆道闭锁; 生化指标; 诊断

Keywords:

biliary atresia; biochemical index; diagnosis

分类号:

R726.5

DOI:

-

文献标志码:

A

摘要:

目的：探讨碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（GGT）、血清总胆汁酸（TBA）在婴儿胆道闭锁（BA）中的诊断价值和临床意义。方法:选取161例婴儿胆汁淤积性肝病患者作为研究对象。根据胆道造影将患儿分为BA胆汁淤组（n=47）和非BA胆汁淤组（n=114），根据月龄将患儿分为1～2月龄组（n=96）、2～3月龄组（n=38）和≥3月龄组（n=27）。根据巨细胞（CMV）抗体和DNA检测结果将CMV阳性患儿分为BA组（n=16）和非BA组（n=22）。分别比较各亚组ALP、GGT、TBA水平。将有差异的结果纳入受试者工作特征（ROC）曲线分析，计算ROC曲线下面积（AUC）和最佳诊断临界值。结果：BA胆汁淤积组 ALP、GGT、TBA 水平均明显高于非 BA胆汁淤积组（Z=4.941、8.163、5.100，均P<0.05）；GGT联合ALP、TBA诊断BA的AUC最大，为0.936（95%CI：0.893～0.978），当GGT=156.50 U/L、ALP=390.50 U/L、TBA=56.50 U/L时，诊断BA的敏感性为93.6%，特异性为82.9%；1～2月龄组GGT联合ALP、TBA诊断BA的AUC最大，为0.979（95%CI：0.956～1.000），当GGT=217.50 U/L、ALP=390.50 U/L、TBA=37.50 U/L时，诊断BA的敏感性为100.0%，特异性为88.4%；2～3月龄组和≥3月龄组均为GGT的AUC值最大，分别为0.894（95%CI：0.787～1.000）、0.885（95%CI：0.758～1.000），诊断界值分别为156.5 U/L、133.0 U/L；CMV感染阳性患儿BA组只有ALP 水平明显高于非 BA 组（Z=4.081，P＜0.001）；ALP的AUC为0.636（95%CI：0.451～0.822），当GGT取值399.5 U/L时，诊断BA的敏感性和特异性分别为87.5%、55.5%。结论：GGT联合ALP和TBA诊断BA的敏感性和特异性较高；GGT对BA有良好的诊断价值，尤其是2月龄及以上的患儿。

Abstract:

Objective：To investigate the diagnostic value and clinical significance of alkaline phosphatase（ALP），γ-glutamyl transpeptidase（GGT），and serum total bile acids（TBA） in infant biliary atresia（BA）. Methods: A total of 161 cases of infantile cholestatic liver disease were selected as the study population. The children were divided into BA cholestasis group（n=47） and non-BA cholestasis group （n=114） based on the results of cholangiography，and then the children was subdivided into 1-2 months old group（n=96），2-3 months old group（n=38） and ≥3 months old group（n=27）based on the age of months. CMV-positive children were divided into BA group（n=16）and non-BA group（n=22） according to the results of giant cell（CMV） antibody and DNA testing. The levels of ALP，GGT，and TBA were compared between each group，respectively. The results with differences were included in the subject operating characteristic curve（ROC） analysis，and the area under the ROC curve（AUC） and the optimal diagnostic threshold were calculated. Results: The levels of ALP，GGT and TBA in the BA cholestasis group of children with cholestasis were significantly higher than those in the non-BA cholestasis group（Z=4.941，8.163，5.100，all P<0.05）；the AUC of GGT combined with ALP and TBA for the diagnosis of biliary atresia was the largest at 0.936（95% CI：0.893-0.978），when GGT=156.50 U/L，ALP=390.50 U/L，TBA= 56.50 U/L，the sensitivity was 93.6% and the specificity was 82.9%. The AUC of GGT combined with ALP and TBA for the diagnosis of BA was the largest in the 1-2 month old group，at 0.979（95% CI：0.956-1.000），with a sensitivity of 100.0% and specificity of 88.4% when GGT=217.50 U/L，ALP=390.50 U/L and TBA=37.50 U/L；the AUC of GGT for the diagnosis of BA was the largest in the 2-3 month old group and ≥3 month old group，at 0.894（95%CI: 0.787-1.000） and 0.885 （95%CI：0.758-1.000），with diagnostic cut-off values of 156.5 U/L and 133.0 U/L，respectively. Only ALP levels were significantly higher in the BA group than in the non-BA group in children with CMV infection（Z=4.081，P<0.001）. The AUC of ALP was 0.636（95% CI：0.451-0.822），and the sensitivity and specificity of the diagnosis of BA were 87.5% and 55.5%，respectively，when GGT was taken as 399.5 U/L. Conclusion：The sensitivity and specificity of GGT combined with ALP and TBA were high in the diagnosis of BA；GGT had good diagnostic value for BA，especially in children aged 2 months and above.

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备注/Memo

备注/Memo:

基金项目 新疆维吾尔自治区自然科学基金（2021D01A38）
作者简介 张瑞丰（1998-），男，硕士在读，研究方向：小儿外科疾病；通信作者：詹江华，E-mail:zhanjianghuatj@163.com。

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更新日期/Last Update: 2022-09-20