摘要
目的探讨肝功能检查和门冬氨酸氨基转移酶／血小板指数（aspartate aminotr-ans—ferase-to-platelet ratio index，APRI）与肝脏纤维化程度的关系，阐述其在BA肝纤维化评估中的临床价值。方法收集2006年2月至2011年8月间在我院治疗的胆道闭锁患儿38例和胆汁淤积综合征患儿25例为研究对象。临床观察指标包括肝功能检查，肝脏活检切片，血小板指数；肝硬化程度采用Metavir分类，APRI的诊断陛评估采用ROC曲线，应用SPSS16．O统计学软件进行统计分析。并对本组患儿进行随访，随访时间是3～69个月（平均随访时间：20．7个月）。结果胆道闭锁组患儿ALP、γ-GT、DBIL（564．14±257．75、153．36±97．47、7．55±2．57）较胆汁淤积综合征组患儿存在明显升高（P〈0．05）；胆道闭锁肝硬化组患儿Age、ALT、AST、γ-GT（84．50±24．72、225．07±109．68、331．64±130．93、951．07±667．24）较非肝硬化组明显升高，两组差异具有统计学意义（P〈0．05）；胆汁淤积综合征肝纤维化组患儿Age、ALT、AST（84．76±14．28、159．92±61．76、238．15±62．60）较非肝纤维化组（54．17±11．17、98．92±58．08、151．17±41．44）明显升高，两组差异具有统计学意义（P〈0．05）。患儿绘制APRI的ROC曲线，用于判定肝硬化程度，胆道闭锁组敏感性为79％，特异性为88％；胆汁淤积综合征组敏感性为91％，特异性为79％。胆道闭锁中肝硬化组病死率显著高于非肝硬化组，且自体肝生存情况低于非肝硬化组。结论肝功能检查可以作为胆道闭锁的初步判断指标，绘制APRI的ROC曲线对于评价胆道闭锁及胆汁淤积综合征患儿的肝脏纤维化情况均有较高准确性和可靠性，可用于预测预后和提早做好肝移植准备，因其简单、无创性可以在临床上广泛应用。
Objective To investigate the correlation between the degree of liver fibrosis and as- partate aminotransferase-to-platelet ratio index in the children with biliary atresia. Methods This study included 38 cases of BA patients and 25 cases of patients with inspissated bile syndrome between February 2006 and August 2011. Several laboratory tests including serum liver function and APRI were performed. Liver wedge biopsy specimens were obtained during the surgical procedure, and his-topathologic analyses were performed using the Metavir classification. Statistical analysis was done u singSPSS 16.0. Results The levels of ALP , γ-GT, DBIL（564.14±257.75,153.36±97.47.7.55±2. 57）in the biliary atresia group were significantly higher than that of the inspissated bile syndrome group （P〈0. 05）. Furthermore, Age, the level of ALT, AST, γ-GT （84. 50 ± 24. 72,225. 07 ± 109. 68,331.64 ± 130. 93,951.07 ± 667.24）of the non-cirrhosis group were significantly higher than that of cirrhosis group （P〈0. 05）. There were significant difference in age, the level of ALT, AST between non-fibrosis group（54. 17 ± 11.17.98. 92 ± 58. 08. 151.17 ± 41.44）and fibrosis group（84. 76 ± 14. 28,159. 92± 61.76,238. 15 ± 62.61）） based on APRI（P〈0. 05）. Diagnostic accuracy for liver fi-brosis degree was assessed by receiver operator curve （ROC） analysis. The sensitivity and the specific-ity of biliar atresia group were 79o/oo and 88~//00, respectively. The sensitivity and the specificity of in-spissated bile syndrome group were 91% and 79%, respectively. Conclusions Liver function test may be used as a preliminary screening test for hiliary atresia. Rendering the ROC curves of APRI for eval-uating hepatic fibrosis of biliary atresia and inspissated bile syndrome both have high accuracy and reli- ability. This simple and non-invasive test can be widely used in clinical practice.
出处
《中华小儿外科杂志》
CSCD
北大核心
2012年第11期815-819,共5页
Chinese Journal of Pediatric Surgery
基金
天津市卫生局重点攻关项目（项目编号：11KG120）
关键词
胆道闭锁
胆汁淤积
肝纤维化
APRI
Biliary atresia
Cholestasis
Liver fibrosis
Aspartate aminotransferase-to-platelet ratio index
