Chu Bo, Jiang Li-rong, Zhou Sha, Xu Ya-zhen, Zhang Bin, Deng Zhao-hui
Department of Gastroenterology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2009 Dec;11(12):953-6.
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.
Serum levels of seven conventional serological markers: alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (gamma-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 gamma-GT, TB and CB were performed to elevate diagnostic efficiency.
Compared with the IHS group, the BA group had significantly increased serum ALT, AST, gamma-GT, TB and CB levels (p<0.01). The area under ROC (AUCROC) of AST, gamma-GT, CB and TB was 0.77, 0.881, 0.841 and 0.87, respectively. gamma-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 gamma-GT and TB was lower than that of CB. After the parallel tests, the sensitivity and negative predictive value of gamma-GT, CB and TB increased to 100%. After the serial tests, the specificity of gamma-GT, CB and TB increased to 90.4% and the positive predictive value increased to 87.5%.
The measurement of gamma-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.
本研究旨在通过使用受试者工作特征（ROC）曲线分析肝功能检查中的七种常规血清学标志物，探讨肝功能检查在婴儿肝炎综合征（IHS）和胆道闭锁（BA）鉴别诊断中的价值。
测定103例IHS患儿和60例BA患儿血清中七种常规血清学标志物的水平：丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、γ-谷氨酰转肽酶（γ-GT）、碱性磷酸酶（ALP）、总胆红素（TB）、结合胆红素（CB）和血清白蛋白（ALB）。采用ROC曲线评估敏感性、特异性、阳性和预测值以及最佳截断值。进行γ-GT、TB和CB的联合试验（并联试验和串联试验）以提高诊断效率。
与IHS组相比，BA组血清ALT、AST、γ-GT、TB和CB水平显著升高（p<0.01）。AST、γ-GT、CB和TB的ROC曲线下面积（AUCROC）分别为0.77、0.881、0.841和0.87。γ-GT在BA诊断中显示出最高的AUCROC、特异性、阳性预测值和阳性似然比，依次为CB、TB和AST。CB的阴性预测值最高，其次是TB。CB的阴性似然比最低但其约登指数最高。γ-GT和TB的约登指数低于CB。并联试验后，γ-GT、CB和TB的敏感性和阴性预测值提高到100%。串联试验后，γ-GT、CB和TB的特异性提高到90.4%，阳性预测值提高到87.5%。
γ-GT、TB和CB水平的测定在BA和IHS的鉴别诊断中有价值。并联试验阳性患者需要进行影像学检查。
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