胆道闭锁患儿早期胆红素变化

摘要

目的：比较胆道闭锁及婴儿肝炎综合征（以下简称为婴肝）患儿出生后2个月内胆红素水平，分析胆道闭锁和婴肝患儿胆红素变化的规律，探讨胆道闭锁患儿胆红素水平与年龄的内在联系。方法选择2000年1月至2009年4月因黄疸于出生后60 d 内行血清胆红素检查的胆道闭锁患儿68例，为胆道闭锁组；2005年1月至2009年4月因婴儿肝炎综合征于出生后60 d 内行血清胆红素检查的患儿72例，为婴肝组；正常对照组为近1年内非肝脏疾病于出生60 d 内行胆红素检查的54例患儿。分析各组血清胆红素水平随年龄变化的特点，并计算检查时年龄、直接胆红素与总胆红素的比例。将上述结果分组进行对比分析，研究各组血清胆红素与年龄之间的关系。结果胆道闭锁患儿血清总胆红素、直接胆红素水平明显高于婴肝组患儿（P ＜0.05）。胆道闭锁组患儿出生后10 d 内血清总胆红素、直接胆红素水平明显高于婴肝组和正常对照组。胆道闭锁组患儿直接胆红素水平、直接胆红素与总胆红素比值随年龄增长缓慢升高，而婴肝组患儿直接胆红素水平、直接胆红素与总胆红素比值在出生20 d后变化甚微。结论胆道闭锁患儿总胆红素水平在新生儿期逐渐下降，1个月后再缓慢升高；且并不是一开始就表现为以直接胆红素升高为主的高胆红素血症，出生后20 d 内其与婴肝相似，均表现为以间接胆红素升高为主的黄疸。年龄小于2个月的婴儿，直接胆红素占总胆红素的水平超过0．7可以作为诊断胆道闭锁的线索。%Objective Investigate the correlation between bilirubin level and age,in accordance with the bilirubin level of patients with biliary atresia(BA)during the first two months after birth. Methods 68 pa-tients with BA were collected in the BA group,72 patients with infantile hepatitis were collected in the infantile hepatitis group,and 54 patients with non-liver disease were collected in the normal control group.All the pa-tients underwent bilirubin examination within 2 months after birth.The patients′serum bilirubin level in relation to their age was analyzed,and their age as well as the proportion of direct bilirubin and total bilirubin were cac-ulated.Statistical analysis was made to find the relationship between bilirubin and age.Results The total bili-rubin and the direct bilirubin of patients with biliary atresia were much higher than those with infantile hepatitis (P <0.05).The patients in the BA group,compared with those in the infantile hepatitis group and normal con-trol group,had higher level of total and direct bilirubin within 10 days after birth.The direct bilirubin level,and the ratio of the direct bilirubin to the total bilirubin increase slowly with days in the BA group,while there is lit-tle change found in the infantile hepatitis group within 20 days after birth. Conclusions During 20 days after birth,patients with biliary atresia had hyperbilirubinemia,mainly in indirect bilirubin,mistaken for infantile hepatitis easily.The direct bilirubin of patients with biliary atresia increased with days.To the infants within 2 months after birth,the ratio of direct bilirubin to total bilirubin can indicate BA if over 0.7.