Ito F, Ando H, Watanabe Y, Ito T
Department of Surgery, Branch Hospital, Nagoya University School of Medicine, Japan.
J Pediatr Surg. 1995 Apr;30(4):596-9. doi: 10.1016/0022-3468(95)90140-x.
Bilirubin conjugates in the serum of cholestatic pediatric patients were investigated with Micronex high-performance liquid chromatography. Serum bilirubin was resolved into four fractions: delta bilirubin (Bd), bilirubin diglucuronide (BDG), bilirubin monoglucuronide (BMG), and unconjugated bilirubin (Bu). The conjugated bilirubin (BDG+BMG) fraction in preoperative patients with biliary atresia (BA) was 48.8 +/- 5.1%, which was significantly higher than that in patients with infantile hepatitis (P < .01). Among postoperative BA patients who recovered from jaundice, the Bd fraction increased during the first month, remained elevated (60% to 80%) for a while, and then gradually decreased. After 6 months, the Bd fraction decreased to 30% in the jaundice-free survivors, but was still higher than that in controls (7%). Even after the total serum bilirubin had normalized (< or = 1.0 mg/dL), distribution of bilirubin fractions remained abnormal, possibly reflecting impaired hepatic excretion of bilirubin. In conclusion, measurement of the conjugated bilirubin fraction enabled BA to be differentiated from infantile hepatitis, and the delta bilirubin fraction proved to be an important indicator of cholestasis in postoperative BA patients with normal serum bilirubin.
采用Micronex高效液相色谱法对胆汁淤积性儿科患者血清中的胆红素结合物进行了研究。血清胆红素被分为四个组分：δ胆红素（Bd）、胆红素二葡萄糖醛酸酯（BDG）、胆红素单葡萄糖醛酸酯（BMG）和未结合胆红素（Bu）。术前胆道闭锁（BA）患者的结合胆红素（BDG+BMG）组分占48.8±5.1%，显著高于婴儿肝炎患者（P<.01）。在术后黄疸消退的BA患者中，Bd组分在第一个月增加，持续升高一段时间（60%至80%），然后逐渐下降。6个月后，无黄疸存活者的Bd组分降至30%，但仍高于对照组（7%）。即使血清总胆红素已恢复正常（≤1.0mg/dL），胆红素组分的分布仍不正常，这可能反映了肝脏胆红素排泄功能受损。总之，结合胆红素组分的测定有助于鉴别BA和婴儿肝炎，而δ胆红素组分被证明是血清胆红素正常的术后BA患者胆汁淤积的重要指标。
