本文選題：先天性肝外膽道閉鎖 + 肝炎綜合征�。� 參考：《山東醫(yī)藥》2017年41期

【摘要】：目的探討6 h99mTc-二乙基乙酰苯胺亞氨二醋酸(EHIDA)肝膽靜態(tài)顯像半定量分析法聯(lián)合血清谷氨酰轉(zhuǎn)肽酶(GGT)對(duì)嬰兒先天性肝外膽道閉鎖(EHBA)的診斷價(jià)值。方法選取行手術(shù)治療的持續(xù)性黃疸患兒159例,根據(jù)手術(shù)評(píng)價(jià)結(jié)合病理診斷分為EHBA組82例、嬰兒肝炎綜合征(IHS)組77例。檢測(cè)兩組血清GGT,并行99m Tc-EHIDA肝膽動(dòng)態(tài)顯像,計(jì)算6 h肝膽平面顯像半定量法指標(biāo)腸本差值(即6 h腸本差值)。比較兩組間GGT水平、6 h腸本差值,繪制各自受試者工作特征(ROC)曲線,并分別確定診斷EHBA的閾值。同時(shí)比較GGT水平、6 h腸本差值及6 h腸本差值與GGT聯(lián)用(即聯(lián)合診斷)對(duì)EHBA的診斷效能。結(jié)果兩組間血清GGT水平、6 h腸本差值比較差異有統(tǒng)計(jì)學(xué)意義(P均0.05),GGT水平和6 h腸本差值診斷EHBA的效能均較高[ROC曲線下面積(AUC)分別為0.895、0.753]。6 h腸本差值診斷EHBA的靈敏度、特異性、準(zhǔn)確性、陽(yáng)性預(yù)測(cè)值分別為86.59%(71/82)、50.65%(39/77)、69.18%(110/159)、65.14%(71/109);GGT的相應(yīng)參數(shù)分別為74.39%(61/82)、90.91%(70/77)、82.39%(131/159)、89.71%(61/68)。6 h腸本差值的靈敏度優(yōu)于GGT值(χ~2=3.883,P0.05),但特異性、準(zhǔn)確性和陽(yáng)性預(yù)測(cè)值低于GGT值(χ~2分別為30.172、7.557和13.331,P均0.01)。聯(lián)合診斷與單用6 h腸本差值相比,診斷EHBA的特異性、準(zhǔn)確性、陽(yáng)性預(yù)測(cè)值提高(χ~2分別為35.136、21.058和20.078,P均0.05),分別達(dá)93.51%(72/77)、89.94%(143/159)和93.42%(71/76)。結(jié)論 6 h肝膽靜態(tài)顯像半定量法聯(lián)合血清GGT可提高對(duì)EHBA診斷的特異性和準(zhǔn)確性。
[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.

【作者單位】： 廣西醫(yī)科大學(xué)第一附屬醫(yī)院;懷化市第一人民醫(yī)院;
【基金】：廣西醫(yī)療衛(wèi)生適宜技術(shù)開(kāi)發(fā)與推廣應(yīng)用項(xiàng)目(S201669)
【分類號(hào)】：R725.7
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本文編號(hào)：1849931