抗平滑肌抗体和肝酶在肝外胆道闭锁与特发性新生儿肝炎鉴别诊断中的价值
Diagnostic value of anti-smooth muscle antibodies and liver enzymes in differentiation of extrahepatic biliary atresia and idiopathic neonatal hepatitis.
作者信息
Rafeey Mandana, Saboktakin Lida, Hasani Jamshid Shoa, Naghashi Shahnaz
机构信息
Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Department of Pediatrics, Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
出版信息
Afr J Paediatr Surg. 2016 Apr-Jun;13(2):63-8. doi: 10.4103/0189-6725.182558.
BACKGROUND
We aimed to evaluate the diagnostic value of anti-smooth muscle antibodies (ASMA) and two liver markers (gamma-glutamyl transpeptidase [GGT] and alkaline phosphatase [ALP]) for differentiating between patients with extrahepatic biliary atresia (EHBA) and idiopathic neonatal hepatitis (INH).
MATERIALS AND METHODS
During April 2010-2011, all infants at 2 weeks of age who were diagnosed with cholestasis and admitted to Children's Hospital of Tabriz were enrolled. Based on the results of physical examination, laboratory, imaging and pathological studies, neonates were divided into two groups (EHBA and INH). Receiver operating characteristics analysis was used to define sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for ASMA, GGT and ALP.
RESULTS
Thirty neonates with cholestasis (18 with EHBA and 12 with INH) and mean age of 54.66 25.86 days were enrolled. Total and direct bilirubin, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase and ASMA titres were highly not significant (P > 0.05) in patients with INH. GGT (P = 0.008) and ALP (P = 0.01) had statistically significant differences that were higher in patients with EHBA. The sensitivity, specificity, PPV and NPV, accuracy, LR+ and LR- of SMA in differentiating cases with BA were 66.7%, 75%, 80% 60%, 70%, 2.68 and 0.44, respectively. For GGT, the values were 88.9%, 66.7%, 80%, 80%, 79.1%, 3.08 and 0.31, respectively. Finally, for ALP, the values were 77.8%, 75%, 82.4%, 69.2%, 80%, 2.66 and 0.24, respectively.
CONCLUSION
Our study showed that ASMA may be a useful biomarker for differentiation of EHBA from INH. Further studies with larger samples are recommended for confirming the results of this study.
背景
我们旨在评估抗平滑肌抗体（ASMA）以及两种肝脏标志物（γ-谷氨酰转肽酶[GGT]和碱性磷酸酶[ALP]）在鉴别肝外胆道闭锁（EHBA）和特发性新生儿肝炎（INH）患者中的诊断价值。
材料与方法
在2010年4月至2011年期间，纳入了大不里士儿童医院所有2周龄诊断为胆汁淤积的婴儿。根据体格检查、实验室检查、影像学检查和病理研究结果，将新生儿分为两组（EHBA和INH）。采用受试者工作特征分析来确定ASMA、GGT和ALP的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。
结果
纳入了30例胆汁淤积新生儿（18例EHBA和12例INH），平均年龄为54.66±25.86天。INH患者的总胆红素和直接胆红素、血清谷草转氨酶、血清谷丙转氨酶和ASMA滴度差异均无统计学意义（P>0.05）。GGT（P=0.008）和ALP（P=0.01）在EHBA患者中具有统计学显著差异且更高。SMA在鉴别BA病例中的敏感性、特异性、PPV、NPV、准确性、阳性似然比（LR+）和阴性似然比（LR-）分别为66.7%、75%、80%、60%、70%、2.68和0.44。对于GGT，这些值分别为88.9%、66.7%、80%、80%、79.1%、3.08和0.31。最后，对于ALP，这些值分别为77.8%、75%、82.4%、69.2%、80%、2.66和0.24。
结论
我们的研究表明，ASMA可能是区分EHBA和INH的有用生物标志物。建议进一步进行更大样本量的研究以证实本研究结果。
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