血清γ-谷氨酰转肽酶联合直接胆红素诊断婴儿胆道闭锁的价值

Value of serum gamma-glutamyl transpeptidase combined with direct bilirubin in the diagnosis of biliary atresia in infants

摘要:

目的 探讨血清γ-谷氨酰转肽酶（GGT）联合直接胆红素（DB）对胆道闭锁的诊断价值。方法 选取2010年7月至2018年12月住院治疗的胆汁淤积症患儿667例为研究对象，根据术中胆管造影结果和随访情况，将患儿分为胆道闭锁组（n=234）和胆汁淤积组（n=433）。比较两组的发病年龄、性别，以及血清总胆红素（TB）、DB、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆汁酸（TBA）、GGT水平。将有统计学意义的指标纳入受试者工作特征曲线（ROC）分析，计算ROC曲线下面积（AUC）和最佳诊断界值。结果 胆道闭锁组患儿发病年龄早于胆汁淤积组（P < 0.001）。两组患儿性别、ALT及AST水平比较差异无统计学意义（P > 0.05）。胆道闭锁组TB、DB、TBA、GGT水平显著高于胆汁淤积组（P < 0.05）。GGT联合DB诊断胆道闭锁的AUC最大，为0.892（95% CI：0.868~0.916）。当GGT取值为324.0 U/L，DB取值为115.1 μmol/L时，GGT与DB联合诊断胆道闭锁的敏感度和特异度分别为79.8%、83.2%。结论 GGT联合DB诊断胆道闭锁的敏感度和特异度较高，可作为诊断胆道闭锁的有效指标之一。

Abstract:

Objective To study the value of serum gamma-glutamyl transpeptidase (GGT) combined with direct bilirubin (DB) in the diagnosis of biliary atresia. Methods A total of 667 infants with cholestasis who were hospitalized and treated from July 2010 to December 2018 were enrolled as subjects. According to the results of intraoperative cholangiography and follow-up, they were divided into biliary atresia group with 234 infants and cholestasis group with 433 infants. The two groups were compared in terms of age of onset, sex, and serum levels of total bilirubin (TB), DB, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bile acid (TBA), and GGT. A receiver operating characteristic (ROC) curve analysis was performed for indices with statistical significance, and the area under the ROC curve (AUC) and the optimal cut-off value for diagnosis were calculated. Results The biliary atresia group had a significantly younger age of onset than the cholestasis group (P < 0.001). There were no significant differences in sex, ALT, and AST between the two groups (P > 0.05), while the biliary atresia group had significantly higher serum levels of TB, DB, TBA, and GGT than the cholestasis group (P < 0.05). GGT combined with DB had the highest AUC of 0.892 (95% confidence interval:0.868-0.916) in the diagnosis of biliary atresia. At the optimal cut-off values of 324.0 U/L for GGT and 115.1 μmmol/L for DB, GGT combined with DB had a sensitivity of 79.8% and a specificity of 83.2% in the diagnosis of biliary atresia. Conclusions GGT combined with DB has high sensitivity and specificity in the diagnosis of biliary atresia and can be used as an effective indicator for diagnosis of biliary atresia in infants.