Rafeey Mandana, Saboktakin Lida, Shoa Hassani Jamshid, Farahmand Fatemeh, Aslanabadi Saied, Ghorbani-Haghjou Amir, Poorebrahim Sadegh
Department of Pediatrics, Pediatric Health Research Center.
Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Pediatr. 2014 Oct;24(5):623-9. Epub 2014 Feb 18.
Extrahepatic biliary atresia (EHBA) is one of the main causes of neonatal cholestasis. Its early diagnosis could increase the survival of the infants with early surgery. We evaluated the diagnostic accuracy of procalcitonin and apolipoprotein E (Apo-E) levels in infants with and without EHBA.
This prospective study included 18 infants with EHBA and 15 infants with other causes of cholestasis. Blood samples were taken from each patient and different markers including procalcitonin and Apo-E levels were measured. ROC analysis was used to define sensitivity, specificity, positive and negative predictive value (PPV and NPV) for procalcitonin and Apo-E. Findings : There was a significantly positive correlation between Apo-E and SGOT (r=0.37, P=0.03), SGPT (r=0.38, P=0.02) and GGT (r=0.38, P=0.02), and an inverse correlation between procalcitonin and GGT (r=-0.45, P=0.01). Area under curve (AUC) for procalcitonin was 0.69 (P=0.05) with cut-point of 0.735 ng/ml. The sensitivity, specificity, PPV and NPV was 67%, 61%, 69% and 59%, respectively. AUC for Apo-E was 0.68 (P=0.06) for cut-point of 61.25 ng/ml with sensitivity, specificity, PPV and NPV of 67%, 67%, 71% and 67%, respectively.
Both PCT and Apo-E have relatively good accuracy in diagnosing EHBA cases; we could not rely on these markers for diagnosis of EHBA, however, combinations of these biomarkers with other markers and imaging tests could improve their accuracy and may help to achieve a rapid and accurate diagnosis of EHBA.
肝外胆管闭锁（EHBA）是新生儿胆汁淤积的主要原因之一。其早期诊断可提高接受早期手术婴儿的存活率。我们评估了降钙素原和载脂蛋白E（Apo-E）水平在有无EHBA婴儿中的诊断准确性。
这项前瞻性研究纳入了18例EHBA婴儿和15例由其他原因引起胆汁淤积的婴儿。采集每位患者的血样并检测包括降钙素原和Apo-E水平在内的不同标志物。采用ROC分析来确定降钙素原和Apo-E的敏感性、特异性、阳性和阴性预测值（PPV和NPV）。结果：Apo-E与谷草转氨酶（r = 0.37，P = 0.03）、谷丙转氨酶（r = 0.38，P = 0.02）和γ-谷氨酰转肽酶（r = 0.38，P = 0.02）之间存在显著正相关，而降钙素原与γ-谷氨酰转肽酶之间呈负相关（r = -0.45，P = 0.01）。降钙素原的曲线下面积（AUC）为0.69（P = 0.05），截断点为0.735 ng/ml。敏感性、特异性、PPV和NPV分别为67%、61%、69%和59%。Apo-E的AUC为0.68（P = 0.06），截断点为61.25 ng/ml，敏感性、特异性、PPV和NPV分别为67%、67%、71%和67%。
降钙素原和Apo-E在诊断EHBA病例方面都具有相对较好的准确性；然而，我们不能仅依靠这些标志物来诊断EHBA，这些生物标志物与其他标志物及影像学检查相结合可能会提高其准确性，并有助于实现对EHBA的快速准确诊断。
