【摘要】 目的 探讨声触诊弹性成像(sound touch elastography, STE)联合血清谷氨酰转肽酶(gamma-glutamyl transpeptidase, GGT)检测对小婴儿胆道闭锁(biliary atresia, BA)的诊断价值。方法 运用STE技术对196例临床初诊为胆汁淤积性黄疸的新生儿和小婴儿进行肝脏硬度值(liver stiffness measurement, LSM)测量，同时收集其同期肝功能指标。将196例临床初诊为胆汁淤积性黄疸的患儿，按照最终诊断分为BA组及非BA组，比较两组间各指标差异，采用受试者操作特性曲线(receiver operating characteristic curve, ROC)评估各指标对BA的诊断效能。结果 196例中，BA组75例，非BA组121例。两组间LSM、GGT、直接胆红素(direct bilirubin, DBIL)、总胆红素(total bilirubin, TBIL)差异有统计学意义(P<0.05);丙氨酸氨基转移酶(alanine aminotransferase, ALT)、天冬氨酸氨基转移酶(aspartate aminotransferase, AST)、间接胆红素(indirect bilirubin, IBIL)差异无统计学意义(P>0.05)。ROC结果显示，LSM的诊断效能最高，最佳截断值为10.95 Kpa, ROC曲线下面积(area under the ROC curve, AUC)为0.926,敏感性、特异性、阳性预测值(positive predictive value, PPV)、阴性预测值(negative predictive value, NPV)、准确率分别为77.3%、95.9%、90.6%、87.2%、88.3%;其次为GGT,其最佳截断值为187.7 U/L,AUC为0.831,敏感性、特异性、PPV、NPV、准确率分别为80.0%、75.2%、66.7%、85.8%、77.0%。将LSM与GGT并联时，敏感性提升至94.7%;将二者串联时，特异性提升至100%。结论 STE技术及GGT检测均有助于从黄疸患者中诊断出BA,二者联合可在一定程度上改善诊断的敏感性或特异性，从而尽可能减少漏诊或误诊，具有较好的应用价值。更多还原

【Abstract】 Objective To explore the application value of sound touch elastography(STE) technology plus serum gamma-glutamyl transpeptidase(GGT) in the diagnosis of biliary atresia(BA) in infants. Methods A total of 196 cases of neonates and toddlers with clinical manifestations of hyperbilirubinemia were measured for liver stiffness measurement(LSM) by STE and liver function parameters examined at the same time.They were divided into BA(n=75) and non-BA(n=121) groups.And receiver operating characteristic curve(ROC) was utilized for evaluating the diagnostic efficacy of each index for BA. Results Statistically significant inter-group differences existed in LSM,GGT,direct bilirubin(DBIL) and total bilirubin(TBIL)(all P<0.01).No significant inter-group differences existed in alanine aminotransferase(ALT),aspartate aminotransferase(AST) or indirect bilirubin(IBIL)(all P>0.05).ROC analysis revealed that LSM had the highest diagnostic efficiency.Its optimal cut-off value was 10.95 Kpa and the area under the ROC curve(AUC) 0.926.And the sensitivity, specificity, positive predictive value(PPV),negative predictive value(NPV) and accuracy were 77.3%,95.9%,90.6%,87.1% and 88.3% respectively.The next was GGT with an optimal cutoff value of 187.7 U/L and an AUC of 0.831.And sensitivity, specificity, PPV,NPV and accuracy rate were 80.0%,75.2%,66.7%,85.8% and 77.0% respectively.In parallel test, the sensitivity of LSM plus GGT jumped to 94.7%.In serial test, the specificity rose to 100%. Conclusion Both STE and GGT can help to differentiate BA from children with hyperbilirubinemia.The combination of two parameters can improve the diagnostic sensitivity or specificity to a certain extent, thereby reducing missed diagnosis or misdiagnosis as much as possible.更多还原