干化学法建立重庆地区健康儿童肝功能指标参考区间值的横断面调查

doi:10.3969/j.issn.1673-5501.2019.04.004

摘要/Abstract

摘要： 目的通过干化学法建立重庆地区3月龄至18岁健康儿童适合年龄和性别的8项肝功能指标参考值。方法选择3月龄至18岁健康儿童,根据年龄分为5组。采用美国强生公司VITROS 5600干化学分析仪检测8项肝功能指标:血清总胆红素(TB)、总蛋白(TP)、清蛋白(ALB)、丙氨酸转移酶(ALT)、天冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、γ谷氨酰转肽酶(GGT)和乳酸脱氢酶(LDH),比较不同年龄和性别各项肝功能指标的差异,采用非参数方法计算参考区间。结果研究期间3 758名3月龄至18岁健康儿童符合纳入和排除标准,剔除35份不合格标本,3 723份合格标本纳入分析。3月龄至1岁组241份,～3岁组251份,～6岁组939份,～12岁组1 672份,～18岁组620份。①～3岁组TP和ALT,～6岁组TP和AST,～12岁组TB、ALT、AST、GGT和LDH,～18岁组TB、ALB、ALT、AST、ALP、GGT和LDH检测结果均为男高于女,差异有统计学意义(P均<0.05)。②ALT、AST和LDH检测结果与年龄呈负相关,TB、TP、ALB、ALP和GGT检测结果与年龄呈正相关。③8项肝功能指标参考区间为TB(μmol·L^-1):3月龄至1岁组1.0~11.0,～18岁组1.0~16.3;TP(g·L^-1):3月龄至3岁组60.2~74.2,～6岁组61.3~78.2,～12岁组62.8~81.5,～18岁组64.9~82.4;ALB:3月龄至18岁组38.4~49.5 g·L^-1;ALT(U·L^-1):3月龄至1岁组15.8~48.4,～12岁组14.0~42.2,～18岁组男14.7~45.7、女12.5~44.8;AST(U·L^-1):3月龄至1岁组23.9~54.3,～3岁组26.4~50.6,～6岁组22.8~45.8,～12岁组18.9~41.2,～18岁组男15.7~36.8、女14.2~33.7;ALP(U·L^-1):3月龄至12岁130.0~318.5,～18岁组男124.2~416.1、女79.9~320.3;GGT(U·L^-1):3月龄至1岁组10.0~30.0,～12岁组9.3~21.3,～18岁组男9.6~28.7、女9.5~26.2;LDH(g·L^-1):3月龄至3岁组165.9~266.0,～6岁组155.3~256.2,～12岁组142.9~240.9,～18岁组男134.3~225.3、女111.3~207.0。结论重庆地区3月龄至18岁健康儿童不同年龄和性别的肝功能水平存在差异,干化学法建立适应年龄和性别的肝功能指标参考区间对相关疾病的诊疗有重要意义。

关键词: 参考区间, 儿童, 干化学, 肝功能

Abstract: Objective To establish age- and gender-specific reference intervals for 8 common liver function tests in healthy children aged 3 months to 18 years in Chongqing by dry chemical method.Methods Healthy children aged 3 months to 18 year were selected and divided into 3 months to 1 years, -3 years, -6 years, -12 years and -18 years old groups according to the rule of growth and development. Serum TB, TP, ALB, ALT, AST, ALP, GGT and LDH were detected by the VITROS 5600 system. Differences in test results of different ages and genders were compared and the reference intervals were calculated using nonparametric methods.Results During the study period, 3,758 healthy children aged 3 months to 18 years met the inclusion and exclusion criteri; 35 unqualified specimens were excluded, and 3,723 eligible specimens were included in the analysis. There were 241 children in the 3 months to 1 year, 251 in the -3 years, 939 in the -6 years old, 1,672 in the -12 years old, and 620 in the -18 years old. ① TP in early childhood, TP and AST in the preschool, TB, ALT, AST, GGT and LDH in the school age, and TB, ALB, ALT, AST, ALP, GGT and LDH in the adolescence were statistically significant between boys and girls (P<0.05), and in the adolescence boys were significantly higher than in those girls. ② ALT, AST and LDH results were negatively correlated with age, and TB, TP, ALB, ALP and GGT were positively correlated with age. ③ The reference intervals of serum TB(μmol·L^-1): 3 months to 1 year 1.0-11.0,1-18 years 1.0-11.0; reference intervals of TP (g·L^-1): 3 months to 3 years 60.2-74.2, -6 years 61.3-78.2, -12 years 62.8-81.5, -18 years 64.9-82.4; reference intervals of ALB (g·L^-1): 3 months to 18 years 38.4-49.5; reference intervals of ALT (U·L^-1): 3 months to 1 year 15.8-48.4,1-12 years 14.0-42.2, -18 years 14.7-45.7 (male), 12.5-44.8 (female); reference intervals of AST (U·L^-1): 3 months to 1 year 23.9-54.3, -3 years 26.4-50.6,-6 years 22.8-45.8, -12 years 18.9-41.2, -18 years 15.7-36.8 (male), 14.2-33.7 (female); reference intervals of ALP (U·L^-1): 3 months to 12 years 130.0-318.5, -18 years 124.2-416.1 (male), 79.9-320.3 (female); reference intervals of GGT (U·L^-1): 3 months to 1 year 10.0-30.0,1-12 years 9.3-21.3, -18 years 9.6-28.7 (male), 9.5-26.2 (female); reference intervals of LDH (g·L^-1): 3 months to 3 years 165.9-266.0, -6 years 155.3-256.2, -12 years 142.9-240.9, -18 years 134.3-225.3 (male), 111.3-207.0 (female).Conclusion There are differences in liver function levels among healthy children aged 3 months to 18 years in Chongqing. The age- and gender-specific pediatric reference intervals are important for the diagnosis and treatment of related diseases.

Key words: Children, Dry chemical, Liver function, Reference interval

饶露蓓, 刘来成, 刘曼, 尹一兵, 陈大鹏. 干化学法建立重庆地区健康儿童肝功能指标参考区间值的横断面调查[J]. 中国循证儿科杂志, 2019, 14(4): 260-265.

RAO Lu-bei, LIU Lai-cheng, LIU Man, YIN Yi-bing, CHEN Da-peng. Cross-sectional of establishing reference interval for liver function of healthy children in Chongqing by dry chemical method[J]. Chinese Journal of Evidence -Based Pediatric, 2019, 14(4): 260-265.

参考文献

[1]Pediatric reference intervals: critical gap analysis an establishment of a national initiative. Clin Biochem, 2006, 39(6): 559-560
[2]CLSI C28-A3. Defining, establishing, and verifying reference intervals in the clinical laboratory, approved guideline-third edition. Clinical and Laboratory Standard Institute, 2010
[3]WHO Multicentre Growth Reference Study Group, WHO Child Growth Standards: Length/Height-For-Age, Weight-For-Age, Weight-For-Length, Weight-For-Height and Body Mass Index-For-Age: Methods and Development, World Health Organization, Geneva, 2006, p. 312
[4]de Onis M, Onyango AW, Borghi E, et al. Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization, 2007, 85(9): 660-667
[5]胡亚美, 江载芳. 诸福棠实用儿科学. 第7版. 北京: 人民卫生出版社. 2002: 2-4
[6]Solberg HE. The theory of reference values Part 5. Statistical treatment of collected reference values. Determination of reference limits. J Clin Chem Clin Biochem, 1983, 21(11): 749-760
[7]Katayev A, Balciza C, Seccombe DW. Establishing reference intervals for clinical laboratory test results: is there a better way? Am J Clin Pathol, 2010, 133(2): 180-186
[8]Shaw JL, Cohen A, Konforte D, et al. Validity of establishing pediatric reference intervals based on hospital patient data: a comparison of the modified Hoffmann approach to CALIPER reference intervals obtained in healthy children. Clin Biochem, 2014, 47(3): 166-172
[9]陈大鹏, 陈元, 刘来成, 等. 重庆地区学龄前和学龄后健康儿童常用肝肾功能检验项目参考区间的调查. 重庆医科大学学报, 2015. 40(5): 785-789
[10]曹科, 罗小娟, 马东礼, 等. 深圳地区健康未成年人群干式化学法血清胆红素和蛋白水平调查. 循证医学, 2016. 16(2): 93-96, 102
[11]Liu J, Dai Y, Lee Y, et al. Pediatric reference intervals of liver and renal function tests from birth to adolescence in Chinese children as performed on the Olympus AU5400. Clin Chim Acta, 2019, 490: 142-146
[12]于凡, 蒲宁婧, 钟永林, 等. 成都地区健康人群干式生化检测指标参考值区间的建立. 国际检验医学杂志, 2016, 37(15): 2092-2095
[13]陈时维, 叶志成, 付盼, 等. 上海地区儿童肾功能生化项目参考区间的建立. 检验医学, 2018, 33(10): 884-887
[14]罗小娟, 曹科, 马东礼, 等. 健康未成年人群干化学法血清酶水平分析. 循证医学, 2015, 15(4): 232-236
[15]张晓红, 张趁, 刘向祎. 不同年龄段儿童血清碱性磷酸酶参考区间的探讨. 检验医学与临床, 2016, 13(19): 2700-2702
[16]Bussler S, Vogel M, Pietzner D, et al. New pediatric percentiles of liver enzyme serum levels (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase): Effects of age, sex, body mass index, and pubertal stage. Hepatology, 2018, 68(4): 1319-1330
[17]曹科, 罗小娟, 马东礼, 等. 基于干式化学法建立深圳地区3月龄至18岁健康儿童青少年心肌酶谱参考区间值. 中国循证儿科杂志, 2015, 10(1): 52-56
[18]孙继云, 蔡皓东. 健康婴幼儿及儿童丙氨酸氨基转移酶和天冬氨酸氨基转移酶参考区间与成人的差异. 中国妇幼保健, 2017, 32(21): 5323-5326
[19]Wanjian G, Jie H, Liang G, et al. Establishment of Reference Interval for Alkaline Phosphatase in Healthy Children of Various Ethnicities, Aged 0-12 Years. Lab Med, 2017, 48(2): 166-171
[20]Higgins V, Hooshmand S, Adeli K. Principal component and correlation analysis of biochemical and endocrine markers in a healthy pediatric population (CALIPER). Clin Biochem, 2019, 66: 29-36
[21]Temple JL, Cordero P, Li J, et al. A Guide to Non-Alcoholic Fatty Liver Disease in Childhood and Adolescence. Int J Mol Sci, 2016, 17(6). pii: E947
[22]Loomba-Albrecht LA, Styne DM. Effect of puberty on body composition. Curr Opin Endocrinol Diabetes Obes, 2009, 16(1): 10-15
[23]Blasutig IM, Jung B, Kulasingam V, et al. Analytical evaluation of the VITROS 5600 integrated System in a pediatric setting and determination of pediatric reference intervals. Clin Biochem, 2010, 43(13-14): 1039-1044
[24]Hoq M, Karlaftis V, Mathews S, et al. A prospective, cross-sectional study to establish age-specific reference intervals for neonates and children in the setting of clinical biochemistry, immunology and haematology: the HAPPI Kids study protocol. BMJ Open, 2019, 9(4): e025897
[25]张优明, 王丽, 骆海涛. 1580名儿童期(2～6岁)血清碱性磷酸酶活性参考区间探讨. 中国卫生产业, 2018, 15(9): 166-167, 170