北京市应用大便比色卡进行胆道闭锁症筛查的临床研究

摘要

目的 探索建立胆道闭锁症的筛查流程及大便比色卡用于胆道闭锁症筛查的方法学评价.方法 对2013年12月4日至2014年4月30日在北京市朝阳区所属的25家助产机构分娩的新生儿发放大便比色卡,家长根据该卡片比对婴儿大便颜色至生后4个月,通过短信、电话和42天门诊进行结果追访,总结大便比色卡筛查胆道闭锁症的结果.结果 共有19 252名新生儿参加了大便比色卡筛查胆道闭锁症,根据2014年1～3月的筛查数与活产数,应用大便比色卡筛查胆道闭锁症的筛查率91.3％;增加短信提醒追访方式后,门诊可疑患儿就诊率由0.65‰增加到1.89‰.大便比色卡阳性结果12例,1例在生后55天确诊胆道闭锁症(Ⅲ型),3例分别于生后75天、47天、55天诊断为巨细胞病毒感染性肝炎、乳儿肝炎、肠道外营养相关性胆汁淤积症.其他8例为一过性大便比色卡阳性便.1例于生后24 h因黄疸住院,7天诊断为胆道闭锁症(Ⅲ型),未发现大便比色卡阳性便.胆道闭锁症的发病率为1∶9626.结论 大便比色卡是简便有效的筛查胆道闭锁症的方法,可早期发现黄疸不明显的患儿,同时还可筛查出其他引起胆汁淤积症的疾病.%Objective To study screening strategies for biliary atresia (BA) and to evaluate the screening method of infant stool color card.Methods A pilot study to screen for biliary atresia using infant stool color card was carried out from December 2013 to April 2014 in Chaoyang district of Beijing.The parents assessed the color of their babies' stool using the card within 4 months after birth.We retrieved the screening results by telephone calls,42-day outpatient follow-up and short message service (SMS) and then summarized the results.Results A total of 19 252 infants were screened for BA using infant stool color card,and the screening coverage was 91.3％.The percentage of patients who were suspected to have BA came to the clinic increased from 0.65‰ to 1.89‰ after application of SMS alerts.There were 12 positive cases on screening,one baby presented positive stool color at the age of 48d and was diagnosed as BA (type Ⅲ) 55 d.Three cases had positive stool color at the age of 75 d,47 d and 55 d,later confirmed to have cytomegalovirus infection hepatitis infant hepatitis,parenternal nutrition associated cholestasis,respectively.The other cases were transiently positive.The estimated incidence of BA was 1∶9626.Conclusions The screening method was efficient and feasible to screen for BA.The stool color card was a simple and effective method for early detection for BA could also be used to screen for other diseases causing cholestasis.