摘要
目的研究小儿先天性胆管扩张症(CBD)伴肝损伤的病理学基础。方法纳入2014年5月—2019年5月于我院收治的138例CBD伴肝损伤患儿为研究对象,开展回顾性分析。根据患儿年龄的不同,将入选的患儿分为A组(1个月~3岁,72例)、B组(4~16岁,66例)。分析两组患儿临床特点,比较肝功能指标谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBil)、直接胆红素(DBil)、间接胆红素(IBil)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(GGT)、白蛋白(Alb)水平,观察血淀粉酶、尿淀粉酶、胆汁淀粉酶、血小板计数、白细胞计数、血红蛋白水平。结果A组以胆总管囊形扩张为主,囊肿直径较大,大部分囊肿远端明显狭窄闭锁,且囊肿内伴蛋白栓、结石,肝大、胆汁淤积明显;B组以梭形扩张为主,大部分囊肿远端开口,囊肿直径相对较小,少数囊肿远端明显狭窄闭锁,少数肝大、胆汁淤积明显。A组患儿黄疸、陶土大便发生率分别为68.1%、72.2%,显著高于B组的18.2%和15.2%(P<0.05),腹痛发生率为38.9%,显著低于B组的95.5%(P<0.05);A组发热、腹胀、呕吐、腹部包块、肝脾大发生率较B组比较差异均无统计学意义(P>0.05)。A组ALT、AST、TBil、DBil、ALP、GGT均显著高于B组(P<0.05),IBil、Alb较B组比较差异均无统计学意义(P>0.05)。A组白细胞计数显著高于B组(P<0.05),胆汁淀粉酶显著低于B组(P<0.05),血淀粉酶、尿淀粉酶、血红蛋白、红细胞计数较B组比较差异均无统计学意义(P>0.05)。结论不同年龄段CBD患儿临床表现不同,伴有不同程度的肝损伤,而胆道梗阻胆汁淤积是患儿肝损伤的病理基础,临床应引起足够重视。
Objective To study the pathological basis of congenital biliary dilatation(CBD)with liver injury in children.Methods 138 cases of CBD with liver injury admitted to our hospital from May 2014 to May 2019 were included as the research object,and a retrospective analysis was carried out.According to the age of the children,the children were divided into group A(72 cases aged from 1 month to 3 years)and group B(66 cases aged from 4 to 16 years).The clinical characteristics of the two groups were analyzed,and the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),alkaline phosphatase(AKP),gamma-glutamyltransferase(GGT),albumin(ALB)were compared.The levels of serum amylase,urine amylase,bile amylase,platelet count,leukocyte count and hemoglobin were observed.Results In group A,cystic dilatation of common bile duct was dominant,cyst diameter was larger,most distal cysts were strictured and atresia,and cysts were accompanied by protein embolus,calculi,hepatomegaly and cholestasis;Group B was dominated by spindle dilatation,with most of the cysts opening at the distal end and relatively small cyst diameter,a few cysts with obvious stenosis and atresia at the distal end,and a few with large liver and obvious cholestasis.The incidence of jaundice and pottery stool in group A was 68.1%and 72.2%respectively,which was significantly higher than that in group B(18.2%and 15.2%(P<0.05),and the incidence of abdominal pain was 38.9%,which was significantly lower than that in group B(95.5%(P<0.05);The incidence of fever,abdominal distension,vomiting,abdominal mass and hepatosplenomegaly in group A was not significantly different from that in group B(P>0.05).ALT,AST,TBIL,DBIL,AKP,GGT in group A were significantly higher than those in group B(P<0.05),while IBIL and ALB were not significantly different from group B(P>0.05).White blood cell count in group A was significantly higher than that in group B(P<0.05),and bile amylase was significantly low
作者
刘永红
何金萍
马顺茂
LIU Yong-hong;HE Jin-ping;MA Shun-mao(General Hospital of North China Petroleum Administration.Cangzhou 062552,Hebei Province,China)
出处
《肝脏》
2020年第7期759-761,共3页
Chinese Hepatology
基金
河北省自然科学基金资助项目(编号2016-1935)。
关键词
小儿
先天性胆管扩张症
肝损伤
病理学
Children
Congenital cholangiectasis
Liver injury
Pathology
