CAJ | 학술논문

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 aminotransferase-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的诊断性评估采用ROC曲线,应用SPSS 16.0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.
목적 탐토간공능검사화문동안산안기전이매/혈소판지수(aspartate aminotransferase-to-platelet ratio index,APRI)여간장섬유화정도적관계,천술기재BA간섬유화평고중적림상개치.방법 수집2006년2월지2011년8월간재아원치료적담도폐쇄환인38례화담즙어적종합정환인25례위연구대상.림상관찰지표포괄간공능검사,간장활검절편,혈소판지수;간경화정도채용Metavir분류,APRI적진단성평고채용ROC곡선,응용SPSS 16.0통계학연건진행통계분석.병대본조환인진행수방,수방시간시3～69개월(평균수방시간:20.7개월).결과 담도폐쇄조환인ALP、γ-GT、DBIL(564.14±257.75、153.36±97.47、7.55±2.57)교담즙어적종합정조환인존재명현승고(P＜0.05);담도폐쇄간경화조환인Age、ALT、AST、γ-GT(84.50±24.72、225.07±109.68、331.64±130.93、951.07±667.24)교비간경화조명현승고,량조차이구유통계학의의(P＜0.05);담즙어적종합정간섬유화조환인Age、ALT、AST(84.76±14.28、159.92±61.76、238.15±62.60)교비간섬유화조(54.17±11.17、98.92±58.08、151.17±41.44)명현승고,량조차이구유통계학의의(P＜0.05).환인회제APRI적ROC곡선,용우판정간경화정도,담도폐쇄조민감성위79％,특이성위88％;담즙어적종합정조민감성위91％,특이성위79％.담도폐쇄중간경화조병사솔현저고우비간경화조,차자체간생존정황저우비간경화조.결론 간공능검사가이작위담도폐쇄적초보판단지표,회제APRI적ROC곡선대우평개담도폐쇄급담즙어적종합정환인적간장섬유화정황균유교고준학성화가고성,가용우예측예후화제조주호간이식준비,인기간단、무창성가이재림상상엄범응용.
Objective To investigate the correlation between the degree of liver fibrosis and aspartate 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 histopathologic analyses were performed using the Metavir classification.Statistical analysis was done using SPSS 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±62.60)based on APRI(P＜0.05).Diagnostic accuracy for liver fibrosis degree was assessed by receiver operator curve(ROC)analysis.The sensitivity and the specificity of biliary atresia group were 79％ and 88％,respectively.The sensitivity and the specificity of inspissated bile syndrome group were 91％ and 79％,respectively.Conclusions Liver function test may be used as a preliminary screening test for biliary atresia.Rendering the ROC curves of APRI for evaluating hepatic fibrosis of biliary atresia and inspissated bile syndrome both have high accuracy and reliability.This simple and non-invasive test can be widely used in clinical practice.