Ye Wen, Rosenthal Philip, Magee John C, Whitington Peter F
*Department of Biostatistics, University of Michigan, Ann Arbor †Departments of Pediatrics & Surgery, UCSF Benioff Children's Hospital, University of California, San Francisco ‡Department of Surgery, University of Michigan, Ann Arbor §Department of Pediatrics, Feinberg Medical School of Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, IL.
J Pediatr Gastroenterol Nutr. 2015 May;60(5):659-63. doi: 10.1097/MPG.0000000000000690.
δ-Bilirubin (Bδ) forms when bilirubin conjugates covalently bind to albumin by way of nonenzymatic transesterification in patients with cholestasis. Infants with cholestasis with biliary atresia form Bδ. The aim of the present study was to investigate the factors determining serum Bδ concentrations in infants with biliary atresia.
Study patients were infants enrolled in a prospective study (PROBE: Clinicaltrials.gov NCT00061828) of biliary atresia. We acquired data of concurrently measured serum bilirubin analytes (total bilirubin [TB], conjugated bilirubin [Bc], and unconjugated bilirubin) and applied graphical methods and linear mixed effects model to study factors contributing to Bδ variability.
Bδ level increased with increasing levels of Bc and TB. In addition, the length of time cholestasis persisted partially determined the level of Bδ. An increase of 1 mg/dL in Bc is related to approximately 0.36 mg/dL increase in Bδ (P < 0.0001); every 100 days of cholestasis is associated with an approximately 1.0 mg/dL increase in Bδ (P < 0.0001) given the same level of Bc. Serum albumin levels are not significantly related to Bδ (P = 0.89).
Bδ levels in infants with biliary atresia increase with increasing levels of Bc and longer duration of cholestasis. Understanding the relation among Bδ, Bc, TB, and direct-reacting bilirubin levels can help in interpretation of the clinical extent of cholestasis in infants and children with biliary atresia, assisting in the diagnosis and management of these infants.
在胆汁淤积患者中，胆红素结合物通过非酶促酯交换反应与白蛋白共价结合时会形成δ-胆红素（Bδ）。患有胆道闭锁的胆汁淤积婴儿会形成Bδ。本研究的目的是调查决定胆道闭锁婴儿血清Bδ浓度的因素。
研究对象为参加一项关于胆道闭锁的前瞻性研究（PROBE：Clinicaltrials.gov NCT00061828）的婴儿。我们获取了同时测量的血清胆红素分析物（总胆红素[TB]、结合胆红素[Bc]和非结合胆红素）的数据，并应用图形方法和线性混合效应模型来研究导致Bδ变异性的因素。
Bδ水平随着Bc和TB水平的升高而升高。此外，胆汁淤积持续的时间部分决定了Bδ的水平。Bc每增加1mg/dL，Bδ约增加0.36mg/dL（P<0.0001）；在Bc水平相同的情况下，胆汁淤积每持续100天，Bδ约增加1.0mg/dL（P<0.0001）。血清白蛋白水平与Bδ无显著相关性（P=0.89）。
胆道闭锁婴儿的Bδ水平随着Bc水平的升高和胆汁淤积持续时间的延长而升高。了解Bδ、Bc、TB和直接反应胆红素水平之间的关系有助于解释胆道闭锁婴幼儿胆汁淤积的临床程度，辅助这些婴儿的诊断和管理。
