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目的 探讨血清大分子碱性磷酸酶 (HMAP)在新生儿胆道闭锁、新生儿肝炎中的差异性 ,以寻找新的对阻塞性黄疸早期诊断有鉴别意义的实验室指标。方法 阻塞性黄疸患儿 3 1例 ,其中胆道闭锁 15例 ,新生儿肝炎 16例 ;非阻塞性黄疸和健康儿各 3 0例作对照。全部标本各取血清1ml,储存于 -80℃冰箱内备检。采用患儿血清中提纯的HMAP做抗原 ,制备特异性单克隆抗体 ,以硝酸纤维素膜片为固相 ,用此特异性单克隆抗体建立测定血清中HMAP的免疫催化方法。同时测定患儿血清碱性磷酸酶总活性 (TALP)和γ 谷氨酰转肽酶 (γ GT) ,并做肝胆B超和肝胆核素扫描检查。所得数据做统计学处理 ,分析比较不同测定值的敏感性与特异性。结果 15例胆道闭锁患儿血清HMAP阳性 14例 ,阳性率为 93 3 % ;16例新生儿肝炎患儿血清HMAP阳性 2例 ,阳性率为 12 5% ,两组比较 ,差异有非常显著意义 (P <0 0 0 5)。在临床资料的统计学处理中 ,两组仅大便颜色差异有显著性 ,其余均无统计学意义。胆道闭锁组和新生儿肝炎组血生化的TALP、γ GT和肝胆核素扫描结果差异均有显著性 ,但其敏感性与特异性分别为 80 0 %、73 3 %、86 7%和 62 5%、68 8%、62 5% ,明显低于HMAP的敏感性 ( 93 3 % )和特异性 ( 87 5% )。结论 血清HMAP在新生儿阻塞?
Objective To investigate the difference of serum alkaline phosphatase (HMAP) in biliary atresia and neonatal hepatitis in neonates, in order to find out new laboratory indexes which are of significance for the early diagnosis of obstructive jaundice. Methods A total of 31 children with obstructive jaundice, including 15 cases of biliary atresia and 16 cases of neonatal hepatitis, and 30 cases of non-obstructive jaundice and healthy children as controls. All specimens were taken serum 1ml, stored in -80 ℃ refrigerator for inspection. The purified monoclonal antibody of HMAP was used as the antigen to prepare specific monoclonal antibody. The nitrocellulose membrane was used as the solid phase, and the specific monoclonal antibody was used to establish the immunoprecipitation method for the determination of HMAP in serum. Serum total alkaline phosphatase activity (TALP) and γ-glutamyl transpeptidase (γ GT) in children were measured at the same time. Hepatobiliary ultrasonography and hepatobiliary radionuclide scanning were performed. The data obtained were statistically processed, analyzed and compared the sensitivity and specificity of different measurements. Results The serum HMAP was positive in 14 of 15 children with biliary atresia, the positive rate was 93.3%. The serum HMAP was positive in 2 of 16 neonates with hepatitis and the positive rate was 125%. There was significant difference between the two groups P <0 0 0 5). In the statistical treatment of clinical data, only two groups of stool color difference was significant, the rest were not statistically significant. The results of TALP, γGT and hepatobiliary radionuclide scanning in biliary atresia group and neonatal hepatitis group showed significant differences, but the sensitivity and specificity were 80 0%, 73 3%, 86 7% and 62 5 respectively %, 68 8% and 62 5%, respectively, which were significantly lower than those of HMAP (93.3%) and specificity (87.5%). Conclusion Serum HMAP is obstructed in neonates?