甲胎蛋白检测对婴儿胆汁淤积症的临床意义

目的探讨血清甲胎蛋白(alpha-fetoprotein,AFP)检测对婴儿胆汁淤积症病情评估的临床价值。方法检测48例婴儿胆汁淤积症患儿按诊断分为胆道闭锁组与肝内胆汁淤积症组并比较两组AFP水平;按初诊时血AFP水平分为<10000μg/L和>10000μg/L组,以死亡、肝移植或等待肝移植、1岁后仍持续或反复黄疸为预后不良指标,分析两组血AFP水平与患儿预后的相关性。结果胆道闭锁组(8697.40±8356.39)μg/L与肝内胆汁淤积症(21290.57±21026.23)μg/L的AFP水平差异有统计学意义(P<0.05)。AFP与婴儿胆汁淤积症预后相关性分析显示,胆道闭锁组与肝内胆汁淤积症组内若AFP>10000μg/L均提示预后较差。结论胆道闭锁组与肝内胆汁淤积症患儿均存在不同程度血清AFP升高,肝内胆汁淤积症组升高更明显,且与预后呈负相关,检测血清AFP水平可为婴儿胆汁淤积症预后提供依据。

Clinical Significance of Detection of Alpha-fetoprotein (AFP) in Infantile Cholestasis

Objective To investigate the clinical value of serum alpha-fetoprotein (AFP) level for assessing the progress and prognosis of infantile cholestasis. Methods A retrospective study was conducted in 48 cases of infantile cholestasis. Patients were divided into intrahepatic cholestasis group and biliary atresia BA group , AFP level were assessed in two groups. Children with death, liver transplantation or waiting for liver transplantation, persistent or recurrent jaundice over 1 year of age were regarded as poor prognosis. According to the serum AFP levels at presentation, each group was further divided into two groups: <10 000 μg/L and >10 000 μg/L groups. The prognoses were compared between the two groups. Results Serum AFP level in patients with intrahepatic cholestasis (8 697.40 μg/L ± 8 356.39 μg/L) was significantly higher than that in biliary atresia group (21 290.57 μg/L ± 21 026.23 μg/L). Regardless of intrahepatic cholestasis and biliary atresia, patients with >10 000 μg/L at presentation had poorer prognosis than those with <10 000 μg/L (P <0.05). Conclusions Serum AFP might both rise in patients with intrahepatic cholestasis and biliary atresia, but the levels of AFP found in the intrahepatic cholestasis group are higher than those in the biliary atresia. Higher AFP values were associated with more severe inflammatory changes in the liver. It can be a prognostic parameter in cholestasis infants. Higher level of AFP in infants with persistent jaundice might indicate poorer prognosis.