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目的探讨总胆汁酸(TBA)对早产儿胃肠外营养相关性胆汁淤积(PNAC)的诊断价值。方法回顾性分析胃肠外营养持续>14天的早产儿资料,按是否合并PNAC分为观察组及对照组,评价两组血清总胆红素(TBil)、直接胆红素(DBil)、TBA、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、谷草转氨酶(AST)、谷丙转氨酶(ALT)之间的差异,并构建受试者工作(ROC)曲线。结果应用胃肠外营养2周后,平均(20.7±3.6)天时,PNAC组血TBA、DBil、ALP、GGT、AST、ALT均高于对照组,差异有统计学意义(P<0.01)。血TBA的ROC曲线下面积为0.908,AST、GGT、ALT、ALP的曲线下面积分别为0.765、0.712、0.711、0.662,均小于TBA,差异有统计学意义(P<0.001)。血TBA取截断值26.2μmol/L时,诊断灵敏度为87.9%,特异度为87.7%,此时诊断的准确度最高,且灵敏度及特异度均大于其他指标。血TBA、ALT、AST、GGT、ALP与DBil呈正相关,r值分别为0.563、0.328、0.331、0.277、0.246(P<0.01)。结论血TBA是诊断PNAC灵敏度和特异度均较高的指标,动态联合监测DBil与TBA更有利于早产儿PNAC的早期诊断。
Objective To investigate the diagnostic value of total bile acid (TBA) for parenteral nutrition-associated cholestasis (PNAC) in preterm infants. Methods Retrospective analysis of parenteral nutrition for> 14 days in preterm infants was conducted. The patients were divided into observation group and control group according to whether PNAC was combined or not, and the levels of serum total bilirubin (TBil), direct bilirubin (DBil), TBA , Alkaline phosphatase (ALP), glutamyltranspeptidase (GGT), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured and the ROC curve was constructed. Results The blood TBA, DBil, ALP, GGT, AST and ALT in the PNAC group were significantly higher than those in the control group after 2 weeks of parenteral nutrition (P <0.01). The area under the ROC curve of blood TBA was 0.908. The area under the curves of AST, GGT, ALT and ALP were 0.765, 0.712, 0.711 and 0.662 respectively, which were all less than TBA (P <0.001). The diagnostic sensitivity of 87.2% and specificity of 87.7% were obtained when the cut-off value of blood TBA was 26.2 μmol / L. The diagnostic accuracy was the highest at this time, and the sensitivity and specificity were all higher than those of other indexes. Blood TBA, ALT, AST, GGT, ALP and DBil were positively correlated, r values were 0.563,0.328,0.331,0.277,0.246 (P <0.01). Conclusion Blood TBA is a sensitive indicator of the sensitivity and specificity of PNAC. Dynamic monitoring of DBil and TBA is more helpful for the early diagnosis of PNAC in preterm infants.