|Abstract: ||背景：膽道閉鎖的早期診斷很重要，因為其預後與葛西手術的時機密切相關。本研究的目的在於闡述利用咖瑪麩胺醯轉移酶(GGT)的血清濃度，以及咖瑪麩胺醯轉移醯對天門冬胺酸轉胺基酶(AST)的比值，來鑑別診斷膽道閉鎖與新生兒肝炎。 方法：本研究共收集93位膽道閉鎖的病童（46位男性及47位女性）及65位新生兒肝炎的病童（45位男性及20位女性），記錄這些膽汁鬱滯病童的GGT，天門冬胺酸轉胺基酶及丙氨酸轉胺基酶(ALT)的血清濃度，來比較這二組病人的GGT的最高血清濃度，GGT對AST的比值，以及GGT對ALT的比值。 結果：膽道閉鎖病童的GGT的血清濃度明顯高於新生兒肝炎病童(353.3±334.4 IU/L vs. 114.8±86 IU/L, P<0.001)。GGT對AST的比值大於2，在68位膽道閉鎖病童中佔55位，在54位新生兒肝炎病童中佔15位(OR=11.0, 95% CI 4.7-25.7, P<0.001)。GGT對ALT的比值大於2的，在65位膽道閉鎖病童中佔54位，在50位新生兒肝炎病童中佔19位(OR=8.01, 95% CI 3.4-19.0, P<0.001)。以GGT的血清值大於300 IU/L、GGT對AST的比值大於2以及GGT對ALT的比值大於2來診斷膽道閉鎖時，其敏感度分別為39.7%、80.9%與83.1%，特異性分別為98.1%、72.2%與62.0%，診斷正確性分別為65.6%、77.1%與73.9%。 結論：咖瑪麩胺醯轉移酶對天門冬胺酸轉胺基酶的比值大於2的情況，可以高度推測為膽道閉鎖而非新生兒肝炎的診斷，而需早一點做進一步的檢查來確定診斷。
Background: Early diagnosis of biliary atresia (BA) is important because the prognosis is closely related to timing of Kasai operation. The aim of this study was to test the clinical application of serum gamma-glutamyl transferase (GGT) concentration and the ratio of serum GGT to aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in differentiating BA from neonatal hepatitis (NH). Methods: Ninety-three (46 male and 47 female) cases of BA and 65 (45 male and 20 female) NH were included in this study. Serum concentrations of GGT, AST, and ALT were measured in all cholestatic infants. The results of peak GGT level, GGT/AST ratio, GGT/ALT ratio were compared between groups. Results: The serum GGT levels were significantly higher in BA patients than those in NH patients (353.3 334.4 IU/L vs. 114.8 86 IU/L, P<0.001). GGT/AST values were over 2 in 55/68 BA and 15/54 NH (OR=11.0, 95% CI 4.7-25.7, P<0.001). GGT/ALT values were over 2 in 54/65 BA and 19/50, NH respectively (OR=8.0, 95% CI 3.4-19.0, P<0.001). A GGT level greater than 300 IU/L had a sensitivity of 39.7% in the diagnosis of BA, GGT/AST over 2 was 80.9 % and GGT/ALT over 2 was 83.1%; the specificities were 98.1%, 72.2% and 62.0%, respectively. The respective accuracies of the diagnosis of BA were 65.6%, 77.1% and 73.9%. Conclusions: GGT/AST ratio over 2 indicates high possibility of biliary atresia and should prompt further investigations to confirm the diagnosis.