背景:正确识别胆道闭锁(BA)患者,同时避免侵入性诊断方法是具有挑战性的。目的确定血清免疫指标对BA与其他原因引起婴儿胆汁淤积的鉴别价值。
方法:回顾性分析手术/组织学诊断为BA的婴儿和其他原因引起胆汁淤积性黄疸的婴儿的资料。患者分为BA组和胆汁淤积控制(CC)组。生化参数,主要淋巴细胞亚群,比较两组间的免疫球蛋白和C3、C4补体水平.
结果:共有129名BA和63名其他原因的胆汁淤积婴儿(CC对照组),中位年龄为2.2个月。CD3+T细胞的水平,CD3+CD4+T细胞,而早熟T细胞及C3、C4水平在BA组明显高于CC组(均P<0.05)。配对相关分析表明,BA组C3和C4与γ-GT呈显著正相关,但不在CC组中。发现五个指标与BA显着相关:粪便颜色,球蛋白,γ-GT,C3和C4。一种融入凳子颜色的模型,γ-谷氨酰转肽酶水平,和C3水平显示ROC曲线下面积(AUC)为0.93,诊断BA的敏感性为93%,特异性为83%。
结论:纳入血清C3水平的模型可用于准确诊断婴儿BA。
BACKGROUND: Correctly identifying patients with biliary atresia (BA), while avoiding invasive diagnostic methods is challenging. The purpose of this study was to determine the value of serum immune indicators for distinguishing BA from other causes of cholestasis in infants.
METHODS: The data of infants with a surgical/histological diagnosis of BA and those with other causes of cholestatic jaundice were retrospectively analyzed. Patients were divided into a BA group and a cholestasis control (CC) group. Biochemical parameters, major lymphocyte subsets, immunoglobin and C3 and C4 complement levels were compared between the groups.
RESULTS: A total of 129 infants with BA and 63 with other causes of cholestasis (CC control group) with a median age of 2.2 months were included in the analysis. The levels of CD3+ T cells, CD3+CD4+ T cells, and premature T cells and the levels of C3 and C4 were all significantly higher in the BA group compared to the CC group (all P<0.05). Pair-wise correlation analyses indicated that C3 and C4 had a significant positive correlation with γ-GT in the BA group, but not in the CC group. Five indices were found to be significantly associated with BA: stool color, globulin, γ-GT, C3 and C4. A model incorporating stool color, gamma-glutamyl transpeptidase level, and C3 level exhibited an area under the ROC curve (AUC) of 0.93, and a sensitivity of 93% and specificity of 83% for the diagnosis of BA.
CONCLUSIONS: Models incorporating serum C3 levels may be useful for accurately diagnosing BA in infants.