The Value Of Modified ^99mTc-EHIDA Hepatobiliary Imaging,Ultrasound And Serum Glutamyl Transpeptidase In The Differential Diagnosis Of CBA And IHS

Objective:To investigate the clinical value of differential diagnosis of CB A and IHS by improvemethod ^99mTc-EHIDA hepatobiliary dynamic imaging combined with ultrasound and serum GGT levels.Methods:The pathological and clinical data of more than 602 children with persistent jaundice?over 2 weeks?who were first hospitalized in jiangxi children's hospital from January 2011 to December 2018 were retrospectively analyzed.According to the inclusion and exclusion criteria,254 patients with persistent jaundice who met the conditions were finally analyzed.After anti-infection,choleretic,liver protection and other treatments,jaundice completely subsided or significantly improved,and exclude congenital genetic metabolic disease,seps is,and common bile duct cyst diagnosed as IHS,jaundice continues to not refund or continues to deepen laparoscopic biliary imagingand ?or? hepatic biopsy diagnosis,thus this study selected 254 cases of children with persistent jaundice CBA in 156 cases,98 cases of IHS.All 254 patients underwent liver funct ion and blood routine blood test before surgery or within 1 week before regular treatment.Clinical observations included AST,GGT,platelet count and calculated the APRi.All patients underwent modified ^99mTc-EHIDA hepatobiliary imaging and abdominal ultrasonography.The indicators of hepatobiliary imaging were mainly distributed in the intestinal tract at 45min and 6h.The main indicato rs of abdominal ultrasound were gallbladder contraction function,gallbladderm orphology,The condition of the gallbladder wall,whether the common bile duct is visible,and whether the liver and spleen are swollen.Evaluate whether there is any difference in GGT level and APRi value between CBA group and IHS group using independent samplet test or non-parametric test;The correlation between APRi and pathological fibrosis grade was analyzed using Spearman rank correlation.The diagnostic variables were fitted by binary logistic regression,and the ROC of the modified hepatobiliary imaging,abdominal ultrasound and serum GGT was used alone and in combination with the diagnosis of CBA.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the three methods for the diagnosis of CBA were compared and analyzed.Results:1.There were no significant differences between the CBA group and the IHS group?P>0.05?in the basic data of 254 cases of children withper sistent jaundice included in this study,such as admission age and gender.2.The serum GGT levels in CBA group and IHS group were 528.86±415.85IU/L and 180.07±172.14IU/L,respectively.There was significant difference between the two groups?t=7.885,P<0.05?.The ROC curve of serum GGT level in the diagnosis of CBA was drawn,taking GGT>306.5IU/L as the optimal threshold value,and obtaining serum GGT level to diagnose CBA performance parameters.There was no significant difference in APRi between CBA group and IHS group?P>0.05?,but the APRi value was significantly correlated with the pathological fibrosis degree of CBA patients?r=0.828,P<0.05?.3.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of modified method ^99mTc-EHIDA hepatobiliary imaging,abdominal ultrasound and serum GGT in the diagnosis of CBA were 97.4%?152/156?and 88.5%?138/156?,respectively.And 62.8%?98/156?,71.4%?70/98?,61.2%?60/98?and 87.8%?86/98?,87.4%?222/254?,78.0%?198/254?and 72.4%?184/254?,84.4%?152/180?,79.1%?144/182?and 89.1%?98/110?,94.6%?70/74?,83.3%?60/72?and 59.7%?86/144?.The efficacy of the three methods for the diagnosis of CBA alone was significant.The sensitivity and negative predictive value of the modified ^99mTc-EHIDA hepatobiliary imaging were significantly higher than those of ultrasound and serum GGT?The sensitivity comparison X² was 5.42 and 12.86 respectively,and the negative predictive value X² was 6.56 and 25.43 respe ctively,both P<0.05?.The specificity of serum GGT was significantly higher than that of modified ^99mTc-EHIDA hepatobiliary imaging and ultrasound?X² was 4.96 and 12.8 respectively,both P<0.05?.4.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of modified ^99mTc-EHIDA hepatobiliary imaging combined with abdominal ultrasound,serum GGT level and abdominal ultrasound combined with serum GGT level were 90.7%?156/172?,72.1%?155/215?and 70.3%?147/209?,61.8%?84/145?,60.1%?59/97?and 66.9%?93/139?,94.5%?240/254?,84.3%?214/254?and 94.5%?240/254?,75.0%?156/208?,80.3%?155/193?and 76.2%?147/193?,84.0%?84/100?,49.6%?59/119?and 60%?93/155?in the diagnosis of CBA,respectively.The efficacy of either or two methods in the diagnosis of CBA is significant:The sensitivity and accuracy of ^99mTc-EHIDA hepatobiliary imaging combined with abdominal ultrasound were significantly higher than that of the modified ⁹9m9m Tc-EHIDA hepatobiliary imaging combined with GGT and ultrasound combined with GGT?X² was 6.74 and 16.22 respectively,both P<0.05?.5.The sensitivity,spe cificity,accuracy,positive predictive value and negative predictive value of modified ^99mTc-EHIDA hepatobiliary imaging,abdominal ultrasound combined with serum GGT level were 94%?156/166?and 82.5%?80/97?,92.9%?236/254?,90.2%?156/173?,88.9%?80/90?,respectively.The efficacy comparison between the three methods combined with diagnosis and either of them is significant:The sensitivity,specificity,positive predictive value and negative predictive value of the three combined diagnosis were significantly higher than either combination?both P<0.05?.6.The area under the ROC curve of CBA for combined use of the three,combination of any two and single diagnosis is:AUC_{three combination}=0.958,AUChepatobiliary imaging+GGT=0.943,AUChepatobiliary imaging+ultrasound=0.909,AUCultrasound_+GGT=0.895,AUC_{hepatobiliary imaging}=0.844,AUC_GGT=0.82,AUC_ultrasound=0.768,it was found that the combination of the three methods,the modified method of ⁹9m9m Tc-EHIDA hepatobiliary imaging combined with ultrasound,the modified method of ^99mTc-EHIDA hepatobiliary imaging combined with serum GGT level in the diagnosis of CBA which ROC curve area above 0.9,and it shows high diagnostic accuracy for CBA.Conclusion:The model modified ^99mTc-EHIDA hepatobiliary imaging combi ned with abdominal ultrasound or?and?serum GGT measurement for early CBA diagnosis have high accuracy,simple,economical,short time and non-invasive method,which is worthy of clinical promotion and application.According to the characteristics of different methods and complementary advantages,the idea of combined application in CBA diagnosis research is worthy of reference.Serum APRi values are useful for non-invasive assessment of the prognosis of children with CBA and the benefit of screening surgery.