肝功能检查在婴儿肝炎综合征和先天性胆道闭锁的鉴别诊断中的价值

Value of the liver function test in differential diagnosis of infantile hepatitis syndrome and biliary atresia

摘要:

目的：该文采用受试者工作特征曲线（ROC曲线）对肝功能检查中常用的7项血清学指标进行分析，探讨常用的肝功能检查在婴儿肝炎综合征（infantile hepatitis syndrome,IHS）和先天性胆道闭锁（biliary atresia,BA）中的鉴别诊断价值。方法：分别检测IHS组（n=103）和BA组（n=60）的丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、γ-谷氨酰基转移酶（γ-GT）、碱性磷酸酶（ALP）、血清总胆红素（TB）、结合胆红素（CB）和血清白蛋白（ALB）等7个生化指标，应用ROC曲线进行分析，评价上述各指标的敏感性和特异性，阳性预测值和阴性预测值，并得到最佳临界值。对γ-GT，TB 和CB采用联合试验，提高诊断效率。结果：与IHS组相比，BA组的ALT、AST、γ-GT、TB 和CB水平显著升高（P<0.01）；AST、γ-GT、CB、TB的ROC曲线下面积（AUCROC）分别为0.77、0.881、0.841、0.87，其AUCROC、特异性、阳性预测值、阳性似然比均为γGT>CB>TB>AST；CB的阴性预测值最高，TB次之。CB的阴性似然比最低；CB的Youden指数最高，γ-GT和TB次之。γ-GT、TB及CB经平行试验，敏感性和阴性预测值均提高至100%；经系列试验，特异性提高至90.4%，阳性预测值提高至87.5%。结论：γ-GT、TB和CB水平对BA有一定诊断价值，平行试验阳性者更需积极做影像学检查。［中国当代儿科杂志，2009，11（12）：953-956］

Abstract:

OBJECTIVE: This study aimed to investigate the value of the liver function test in the differential diagnosis of infantile hepatitis syndrome (IHS) and biliary atresia (BA) by analyzing seven conventional serological markers in this test using receiver operating characteristic (ROC) curves. METHODS: Serum levels of seven conventional serological markers: alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transpeptidase (γ-GT), alkaline phosphatase (ALP), total bilirubin (TB), conjugated bilirubin (CB) and serum albumin (ALB) were measured in 103 children with IHS and 60 children with BA. ROC curves were used to evaluate the sensitivity, specificity, positive and predictive values and optimal cut-off. The united tests (parallel test and serial test) of γ-GT, TB and CB were performed to elevate diagnostic efficiency. RESULTS: Compared with the IHS group, the BA group had significantly increased serum ALT, AST, γ-GT, TB and CB levels (P<0.01). The area under ROC (AUCROC) of AST, γ-GT, CB and TB was 0.77, 0.881, 0.841 and 0.87, respectively. γ-GT showed the highest AUCROC, specificity, positive predictive value and positive likelihood ratio in the diagnosis of BA, followed by CB, TB and AST in turn. The negative predictive value of CB was the highest, followed by TB. The negative likelihood ratio of CB was the lowest but its Youden index was the highest. The Youden index of γ-GT and TB was lower than that of CB. After the parallel tests, the sensitivity and negative predictive value of γ-GT, CB and TB increased to 100%. After the serial tests, the specificity of γ-GT, CB and TB increased to 90.4% and the positive predictive value increased to 87.5%. CONCLUSIONS: The measurement of γ-GT, TB and CB levels are valuable in the differential diagnosis of BA and IHS. An imaging examination is required in the parallel test positive patients.［Chin J Contemp Pediatr, 2009, 11 (12):953-956］