Analysis Of Prognostic Factors Of Cholestatic Liver Disease In Infants

Ohe liver function indexes before and after treatment were studied by analyzing the etiology and outcome of infantile cholestatic hepatopathy(ICH).The clinical manifestations and diagnostic parameters of different etiologies before and after treatment were compared to obtain their high-risk influencing factors and prognosis evaluation indexes.MethodThe clinical medical records of 72 pediatric patients hospitalized in Yuhuangding Hospital affiliated to Qingdao University from March,2014 to March,2018 were retrospectively analyzed.Summarize the sex,age,length of hospital stay,feeding history,chief complaint,jaundice in neonatal period,family history,hepatosplenomegaly,liver function including enzymological indexes: Aspartate transaminase(AST),alanine aminotransferase(ALT);Cholestasis index: alkaline phosphatase(ALP),rglutamyltransferase(R-GT);Bilirubin level: total bilirubin(TBIL),direct bilirubin(DBIL),Indirect Bilirubin(IBIL),virus series,Torch,hepatitis B five,abdominal B overload,hepatobiliary dynamic imaging,inherited metabolic disorders and gene screening,etc.Inclusion criteria: 1.Age < 1 year(including neonatal period)2.Conform to the diagnostic criteria of cholestatic hepatopathy.Diagnostic criteria for infectious cholestatic hepatopathy:(1)occurs in infancy(including neonatal period)or starts to develop disease in infancy.(2)including infectious,hereditary,metabolic or congenital developmental disorders and other causes.(3)Signs of cholestasis and liver disease.(1)The comprehensive signs of cholestasis include jaundice(obvious yellow stain of skin and/or sclera);Feces become lighter(kaoline-like)and urine becomes darker.Very few children can show clinical manifestations such as skin pruritus,scratches,skin edema,etc.The total bile acid(TBA)value increases(congenital liver cell synthesis or bile acid secretion defects are often normal),and other cholestasis indicators such as ALP and r-GT change.The total bilirubin level in blood increased,with direct bilirubin accounting for more than30% of the total bilirubin level.Malnutrition due to deficiency of fat soluble vitamins such as vitamin K,A,D,E,etc.or bleeding tendency due to deficiency of coagulation factors,etc.(2)liver disease signs: pathological liver signs such as liver size(liver rib > 2 cm)or hardening of texture;Hepatic dysfunction such as elevated aspartate transferase(AST)and/or serum alanine transaminase(ALT)values.Exclusion criteria: 1.onset of disease or continuous progression of disease at age > 1.2.Except other diseases that can cause yellow skin stain,hepatosplenomegaly and abnormal liver function.3.Those who cannot provide detailed medical history.Result1.Of 72 infants with cholestasis,39 were boys(54.5%),33 were girls(45.5%),male:female = 1.2: 1.The median age of onset was 49 days(23 days-1 year old).The causes of the disease were cytomegalovirus infection in 27 cases,inherited metabolic disorders in 12 cases,abnormal anatomical structure in 22 cases,septicemia in 1 case,and unknown etiology in 6 cases.Among the causes of abnormal anatomical structure,there were 11 cases of biliary atresia type 3,8 cases of biliary atresia type 1,and 3 case of gallbladder absence.Among the genetic metabolic causes,NICCD was found in 4 cases,nimapek in 2case,Alagille syndrome in 2 case,UGT1A1,TRMU gene in 1 case,familial intrahepatic cholestasis in 1 case,G-6PD deficiency in 1 case,ATP7 B gene abnormality in 1 case,and propionic acidemia in 1 case.2.Persistent stool color changes and hepatomegaly in clinical manifestations of children are specific for diagnosing abnormal biliary anatomy,while spleen swelling,extrahepatic malformation and urinary color changes are non-specific indicators.3.Ganciclovir has a satisfactory clinical effect in treating CMV virus infection.Enzymology and cholestasis of children with CMV virus infection hepatitis have been significantly improved before and after treatment.Diagnostic indexes of children with abnormal biliary anatomy have not been significantly improved after conservative treatment,suggesting poor prognosis.4.The high GGT level is considered to be related to the abnormal biliary anatomy in children with infantile cholestatic hepatopathy.Logistic regression analysis is used to explore the prognostic risk factors of infantile cholestatic hepatopathy.GGT is found to be an influential factor.Before treatment,the higher GGT,the worse the prognosis effect,and the accuracy rate of the model is 81.8%.After treatment,the higher GGT,the worse the prognosis,and the accuracy rate of the model was 81.8%.Conclusion1.The improvement was not obvious in the abnormal bile duct anatomy group,suggesting poor prognosis.2.Fecal color and liver size of infantile cholestatic hepatopathy are important for the differential diagnosis of biliary atresia.3.The high GGT level in children with cholestatic hepatopathy is considered to berelated to biliary tract anatomical abnormalities.It is considered to be a factor with poor prognosis and should be highly vigilant...