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目的研究放射性核素肝胆显像、肝功各酶及胆红素的测定对临床难以鉴别的婴儿肝炎综合征(IHS)和先天性胆道闭锁(EHBA)婴儿持续性黄疸的价值。方法采用速率生化分析法检测36例临床难以鉴别IHS和EHBA的婴儿持续性黄疸空腹血清谷草转氨酶(AST),血清谷丙转氨酶(ALT),血清乳酸脱氢酶(LDH),血清谷氨酰转肽酶(GGT),血清碱性磷酸酶(ALP),血清总胆红素(TBILI),血清直接胆红素(DBILI)及血清间接胆红素(IBILI)。并于当天对患儿行肝胆显像。结果肝胆显像诊断IHS灵敏度为85%(17/20),特异度为100%(16/16);诊断EHBA灵敏度为100%(16/16),特异度为85%(17/20)。患儿血清AST、ALT、LDH、GGT、ALP、TBILI、DBILI及IBILI含量高于参考值范围;TBILI及DBILI的含量在EHBA组高于IHS组(P<0.05)。AST、LDH、ALT、GGT、ALP及IBILI含量在IHS与EHBA组差别无统计学意义(P>0.05)。结论婴儿持续性黄疸均有肝损害。肝胆显像、血清肝功各酶及胆红素测定能无创、安全、较准确地鉴别IHS与EHBA,提高IHS和EHBA患者的诊断,对于婴儿持续性黄疸治疗的选择有重要意义。
Objective To study the value of determination of radionuclide hepatobiliary imaging, liver enzymes and bilirubin in persistent jaundice in infants with infantile hepatitis syndrome (IHS) and congenital biliary atresia (EHBA). Methods The fasting serum AST, ALT, LDH, serum glutamyl transglutaminase (ALT) in 36 infants with persistent IJ and EHBA were detected by rate biochemical analysis. Peptidase (GGT), serum alkaline phosphatase (ALP), serum total bilirubin (TBILI), serum direct bilirubin (DBILI) and serum indirect bilirubin (IBILI). And on the day of children with hepatobiliary imaging. Results The diagnostic sensitivity of IHS was 85% (17/20) and 100% (16/16). The diagnostic sensitivity and specificity of EHBA were 100% (16/16) and 85% (17/20) respectively. The levels of serum AST, ALT, LDH, GGT, ALP, TBILI, DBILI and IBILI in children were higher than the reference value. The contents of TBILI and DBILI in EHBA group were higher than those in IHS group (P <0.05). AST, LDH, ALT, GGT, ALP and IBILI content in IHS and EHBA group no significant difference (P> 0.05). Conclusions Infants with persistent jaundice have liver damage. Hepatobiliary imaging, serum liver enzymes and bilirubin determination of noninvasive, safe, more accurate identification of IHS and EHBA, IHS and EHBA improve the diagnosis of patients with persistent jaundice in the treatment of choice is important.