肝胆静态显像半定量法联合血清GCT对婴儿胆道闭锁的诊断价值

发布时间：2018-05-06 00:20

  本文选题：先天性肝外胆道闭锁 + 肝炎综合征　； 参考：《山东医药》2017年41期

【摘要】：目的探讨6 h99mTc-二乙基乙酰苯胺亚氨二醋酸(EHIDA)肝胆静态显像半定量分析法联合血清谷氨酰转肽酶(GGT)对婴儿先天性肝外胆道闭锁(EHBA)的诊断价值。方法选取行手术治疗的持续性黄疸患儿159例,根据手术评价结合病理诊断分为EHBA组82例、婴儿肝炎综合征(IHS)组77例。检测两组血清GGT,并行99m Tc-EHIDA肝胆动态显像,计算6 h肝胆平面显像半定量法指标肠本差值(即6 h肠本差值)。比较两组间GGT水平、6 h肠本差值,绘制各自受试者工作特征(ROC)曲线,并分别确定诊断EHBA的阈值。同时比较GGT水平、6 h肠本差值及6 h肠本差值与GGT联用(即联合诊断)对EHBA的诊断效能。结果两组间血清GGT水平、6 h肠本差值比较差异有统计学意义(P均0.05),GGT水平和6 h肠本差值诊断EHBA的效能均较高[ROC曲线下面积(AUC)分别为0.895、0.753]。6 h肠本差值诊断EHBA的灵敏度、特异性、准确性、阳性预测值分别为86.59%(71/82)、50.65%(39/77)、69.18%(110/159)、65.14%(71/109);GGT的相应参数分别为74.39%(61/82)、90.91%(70/77)、82.39%(131/159)、89.71%(61/68)。6 h肠本差值的灵敏度优于GGT值(χ~2=3.883,P0.05),但特异性、准确性和阳性预测值低于GGT值(χ~2分别为30.172、7.557和13.331,P均0.01)。联合诊断与单用6 h肠本差值相比,诊断EHBA的特异性、准确性、阳性预测值提高(χ~2分别为35.136、21.058和20.078,P均0.05),分别达93.51%(72/77)、89.94%(143/159)和93.42%(71/76)。结论 6 h肝胆静态显像半定量法联合血清GGT可提高对EHBA诊断的特异性和准确性。
[Abstract]:Objective to explore the diagnostic value of 6 h99mTc- two ethyl acetanilide aminoacetic acid (EHIDA) liver and bile static imaging semi quantitative analysis combined with seroglutamyl transpeptidase (GGT) in the diagnosis of congenital extrahepatic biliary atresia (EHBA) in infants. Methods 159 cases of persistent jaundice were selected, and EHBA was divided into EHBA according to the surgical evaluation and pathological diagnosis. In group 82, 77 cases of infant hepatitis syndrome (IHS) group, two groups of serum GGT were detected, and 99m Tc-EHIDA liver and gallbladder dynamic scintigraphy was used to calculate the difference value of 6 h liver and gallbladder imaging by semi quantitative index (i.e. 6 h enteric difference). The GGT level and 6 h enteral difference between the two groups were compared, and the working characteristics (ROC) curves of the subjects were plotted and the threshold of the diagnostic EHBA was determined respectively. At the same time, the GGT level, the 6 h entero difference and the 6 h enteral difference and the GGT combined diagnosis of EHBA were compared. Results the difference of serum GGT level between the two groups and the 6 h enteral difference was statistically significant (P 0.05), GGT level and 6 h enteric difference value were all higher under [ROC curve area. The sensitivity, specificity, accuracy and positive predictive value of the 6 h enteral difference were 86.59% (71/82), 50.65% (39/77), 69.18% (110/159), 65.14% (71/109), respectively, and the corresponding parameters of GGT were 74.39% (61/82), 90.91% (70/77), 82.39% (131/159), 89.71% (61/68), respectively. The accuracy and positive predictive values were lower than the GGT value (30.172,7.557 and 13.331, P 0.01 respectively). The specificity, accuracy, and positive predictive value of EHBA were improved (35.136,21.058 and 20.078, P 0.05 respectively) in the combined diagnosis and 6 h enteral difference (0.05), respectively, 93.51% (72/77), 89.94% (143/159) and 93.42% (71/76) respectively. Conclusion 6 hepatocytes. The semi quantitative method combined with serum GGT can improve the specificity and accuracy of EHBA diagnosis.

【作者单位】： 广西医科大学第一附属医院;怀化市第一人民医院;
【基金】：广西医疗卫生适宜技术开发与推广应用项目(S201669)
【分类号】：R725.7
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本文编号：1849931