血清总胆汁酸在早产儿胃肠外营养相关性胆汁淤积中的诊断意义

目的：探讨血清总胆汁酸（TBA）在早产儿胃肠外营养相关性胆汁淤积诊断中的意义。方法选取2013年1月至2013年12月应用胃肠外营养（PN）支持治疗14 d 以上的早产儿65例，按照是否合并胃肠外营养相关性胆汁淤积（PNAC）分为对照组（53例）及观察组（12例），对比观察两组早产儿谷丙转氨酶（ ALT）、谷草转氨酶（ AST）、碱性磷酸酶（ ALP）、谷氨酰转肽酶（GGT）、TBA、血清总胆红素（TBil）以及直接胆红素（DBil）之间的差异。结果观察组早产儿血中 ALT、AST、ALP、TBA 及 DBil 均高于对照组，差异有统计学意义（P ﹤0.05）。TBA 的灵敏度和特异度均高于 ALT、AST、ALP、GGT、TBil，差异有统计学意义（P ﹤0.05），且当血清 TBA 为36μmol/ L 时，其血清诊断灵敏度、特异度分别为83.3%、96.2%，此时 TBA 的准确度最高。结论监测血清 TBA可作为早产儿 PNAC 的早期诊断指标。

Diagnostic significance of serum total bile acids in preterm infants with parenteral nutrition associated cholestasis

Objective To investigate the diagnostic significance of serum total bile acids(TBA)inpreterm infants withparenteral nu-trition associated cholestasis. Methods 65 cases ofpreterm infantsever treated with parenteral nutrition for more than14 days in our hospital from Jan 2013 to Dec 2013 were enrolledand divided into the study group,which with parenteral nutrition associated cholestasis(PNAC),and the control group,which without PNAC. The serumlevels of ALT,AST,ALP,GGT,TBA,TBiland DBil were analyzedand compared be-tween the two groups. Results In the study group,serum ALT,AST,ALP,TBA and DBillevels were significantly higher than those in the control group(P ﹤ 0. 05). The sensitivity and specificity of serumTBA were significantly higher than that ofALT,AST,ALP,GGTand TBil (P ﹤ 0. 05),and the respectivesensitivity and specificity of serumTBA were 83. 3% and 96. 2% with highest accuracywhen theserum TBA-reached36 μmol/ L. Conclusion Monitoring the serum TBA is helpfulto early diagnosis ofPNAC inpreterm infants,and has an important clinical significance.