γ-谷氨酰转肽酶联合直接胆红素在不同年龄段儿童对胆道闭锁的诊断价值

doi:10.20274/j.cnki.issn.1674-3865.2025.03.008

中国中西医结合儿科学 ›› 2025, Vol. 17 ›› Issue (3): 231-236.doi: 10.20274/j.cnki.issn.1674-3865.2025.03.008

γ-谷氨酰转肽酶联合直接胆红素在不同年龄段儿童对胆道闭锁的诊断价值

郑丽娟, 薛福敏, 于静()

450018 郑州，郑州大学附属儿童医院、河南省儿童医院郑州儿童医院消化内科

收稿日期:2024-12-30 修回日期:2025-03-09 出版日期:2025-06-25 上线日期:2025-06-25
通讯作者: 于静 E-mail:yujingdoctor@sina.com
作者简介:郑丽娟（1985?），女，医学硕士，副主任医师。研究方向：儿童肝病及消化的诊治
基金资助:
2021年度河南省医学科技攻关计划联合共建项目(LHGJ20210626);河南省二〇二四年科技发展计划项目(242102310056)

Diagnostic value of GGT combined with DBIL for biliary atresia in different age groups of children

Lijuan ZHENG, Fumin XUE, Jing YU()

Children's Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital Zhengzhou Children’s Hospital，Zhengzhou 450018, China

Received:2024-12-30 Revised:2025-03-09 Published:2025-06-25 Online:2025-06-25
Contact: Jing YU E-mail:yujingdoctor@sina.com
Supported by:
Joint Construction Project of Henan Medical Science and Technology Research and Development Program in 2021(LHGJ20210626)

摘要/Abstract

摘要：

目的探讨γ-谷氨酰转肽酶（GGT）联合直接胆红素（DBIL）在不同年龄段对胆道闭锁的诊断价值。方法选取2019年6月至2022年12月就诊于郑州大学附属儿童医院的非胆道闭锁性胆汁淤积患儿71例和胆道闭锁患儿130例作为研究对象。比较两组患儿的性别构成及两组患儿不同年龄段的GGT、碱性磷酸酶（ALP）、DBIL、谷丙转氨酶(ALT)、总胆汁酸(TBA)的差异；将有差异的指标绘制受试者工作特征(ROC)曲线，比较各指标对胆道闭锁的诊断价值。结果（1）不同年龄段胆道闭锁组女童发病率均高于非胆道闭锁组，差异有统计学意义（P<0.05）。（2）年龄30～60 d患儿中，胆道闭锁组GGT、DBIL高于非胆道闭锁组，差异有统计学意义(P<0.05)；其余指标比较差异均无统计学意义(P>0.05)。GGT、DBIL、GGT联合DBIL对胆道闭锁的曲线下面积（AUC）值分别为0.874，0.903，0.927；当选择GGT>175.4 U/L时，对胆道闭锁的敏感度为0.791，特异度为0.844；当选择DBIL>79.0 μmol/L时，对胆道闭锁的敏感度为0.837，特异度为0.844。（3）年龄>60～90 d患儿中，胆道闭锁组GGT、DBIL、TBA高于非胆道闭锁组，差异有统计学意义(P<0.05)；其余指标比较差异均无统计学意义(P>0.05)。GGT、DBIL、GGT联合DBIL对胆道闭锁的AUC值分别为0.910，0.944，0.962；当选择GGT>170.4 U/L时，对胆道闭锁的敏感度为0.909，特异度为0.821；当选择DBIL>74.9 μmol/L时，对胆道闭锁的敏感度为0.932，特异度为0.846。结论（1）对于年龄30～60 d，>60～90 d患儿，GGT、DBIL对胆道闭锁均有较高的诊断效能，两者联合诊断效能更佳。（2）对于小月龄30～60 d患儿，GGT、DBIL已显示出很高的对胆道闭锁的敏感度和特异度，故早期检测肝功能对减少胆道闭锁的漏诊是十分重要的。

关键词: 胆汁淤积, 胆道闭锁, 早期诊断, 儿童

Abstract:

Objective To explore the diagnostic value of gamma glutamyltranspeptidase (GGT) combined with direct bilirubin (DBIL) for biliary atresia in different age groups. Methods A total of 71 children with non?biliary atresia cholestasis and 130 children with biliary atresia who visited Zhengzhou University Children's Hospital from June 2019 to December 2022 were selected as the study subjects. Compare the gender composition of two groups of children and the differences in GGT, alkaline phosphatase (ALP), DBIL, alanine aminotransferase (ALT), and total bile acid (TBA) between two groups of children at different ages.Draw receiver operating characteristic curves (ROC) for the indicators with differences, and compare the diagnostic value of each indicator for biliary atresia. Results (1) The incidence rate in girls with biliary atresia at different ages was higher than that in girls without biliary atresia (P<0.05). (2) Among children aged 30–60 days, the GGT and DBIL levels in the biliary atresia group were higher than those in the non?biliary atresia group, and the difference was statistically significant (P<0.05). The differences in other indicators were not statistically significant (P>0.05). The area under the curve (AUC) values of GGT, DBIL, and GGT combined DBIL for biliary atresia were 0.874, 0.903, and 0.927, respectively.When GGT >175.4 U/L was selected, the sensitivity and specificity for biliary atresia were 0.791 and 0.844 respectively.When DBIL >79.0 μmol/L was selected, the sensitivity and specificity for biliary atresia were 0.837 and 0.844 respectively. (3) Among children aged >60–90 days, the GGT, DBIL, and TBA levels in the biliary atresia group were higher than those in the non?biliary atresia group, and the difference was statistically significant (P<0.05).The differences in other indicators were not statistically significant (P>0.05). The AUC values of GGT, DBIL and GGT combined DBIL for biliary atresia were 0.910, 0.944 and 0.962,respectively.When GGT >170.4 U/L was selected, the sensitivity and specificity for biliary atresia were 0.909 and 0.821, respectively.When DBIL >74.9 μmol/L was selected, the sensitivity and specificity for biliary atresia were 0.932 and 0.846, respectively. Conclusion (1) For children aged 30–60 days and >60–90 days, GGT and DBIL have high diagnostic efficacy for biliary atresia, and the combined diagnostic efficacy of them is even better. (2) For children aged 30–60 days, GGT and DBIL have shown high sensitivity and specificity for biliary atresia. Therefore, early detection of liver function is crucial to reducing missed diagnosis of biliary atresia.

Key words: Cholestasis, Biliary atresia, Early diagnosis, Child

中图分类号:

R657.4+4

郑丽娟, 薛福敏, 于静. γ-谷氨酰转肽酶联合直接胆红素在不同年龄段儿童对胆道闭锁的诊断价值[J]. 中国中西医结合儿科学, 2025, 17(3): 231-236.

Lijuan ZHENG, Fumin XUE, Jing YU. Diagnostic value of GGT combined with DBIL for biliary atresia in different age groups of children[J]. Chinese Pediatrics of Integrated Traditional and Western Medicine, 2025, 17(3): 231-236.

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参考文献 23

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组别	30～60 d			>60～90 d
组别	n	男	女	n	男	女
非胆道闭锁组	32	25（78.1）	7（21.9）	39	27（69.2）	12（30.8）
胆道闭锁组	86	45（52.3）	41（47.7）^a	44	19（43.2）	25（56.8）^a

组别	n	30～60 d
组别	n	GGT（U/L）	ALP（U/L）	DBIL(μmol/L)	ALT(U/L)	TBA(μmol/L)
非胆道闭锁组	71	102.4(72.4,160.8)	574.6(388.9,650.4)	44.4(31.5,75.9)	107.9(60.7,165.8)	95.2(62.5,127.0)
胆道闭锁组	130	278.9(190.7,429.6)	490.1(345.6,582.6)	106.2(86.3,137.8)	95.6(59.7,137.2)	108.8(83.7,134.1)
Z值		-6.235	-1.471	-6.713	-0.478	-1.656
P值		<0.001	0.141	<0.001	0.632	0.098
组别	n	>60～90 d
组别	n	GGT（U/L）	ALP（U/L）	DBIL(μmol/L)	ALT(U/L)	TBA(μmol/L)
非胆道闭锁组	71	98.8(75.0,162.0)	509.9(421.2,651.2)	46.2(30.0,68.5)	133.9(75.2,206.9)	108.0(71.8,130.9)
胆道闭锁组	130	309.1(211.4,681.9)	570.7(451.5,685.1)	109.4(90.5,136.3)	141.5(84.0,246.0)	136.4(106.0,157.2)
Z值		-6.423	-1.077	-6.957	-0.091	-3.157
P值		<0.001	0.282	<0.001	0.927	0.002

γ-谷氨酰转肽酶联合直接胆红素在不同年龄段儿童对胆道闭锁的诊断价值

Diagnostic value of GGT combined with DBIL for biliary atresia in different age groups of children

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指标	AUC	95%CI	临界值	敏感度	特异度	约登指数
GGT	0.874	0.801～0.947	175.4	0.791	0.844	0.635
DBIL	0.903	0.831～0.975	79.0	0.837	0.844	0.681
GGT+DBIL	0.927	0.870～0.983	-	-	-	-

指标	AUC	95%CI	临界值	敏感度	特异度	约登指数
GGT	0.910	0.847～0.973	170.4	0.909	0.821	0.73
DBIL	0.944	0.894～0.995	74.9	0.932	0.846	0.778
TBA	0.702	0.589～0.814	140.1	0.477	0.897	0.374
GGT+DBIL	0.962	0.919～1.000	-	-	-	-

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