Huang Zihan,Zheng Shan.Research advances of gamma-glutamyltransferase in the diagnosis and prognosis of biliary atresia disease[J].Journal of Clinical Pediatric Surgery,2021,20(02):140-144,160.[doi:10.12260/lcxewkzz.2021.02.007]
γ-谷氨酰转肽酶在胆道闭锁诊断和预后评价中的研究进展
- Title:
- Research advances of gamma-glutamyltransferase in the diagnosis and prognosis of biliary atresia disease
- 分类号:
- R657.4+4 R726
- 摘要:
- 胆道闭锁是小儿外科常见疾病，早期诊断困难，预后差。γ-谷氨酰转肽酶（gamma-glutamyltransferase，GGT）是谷胱甘肽代谢的关键酶，广泛存在于人体各组织中，主要位于细胞膜外表面。肝脏中GGT主要分布于肝细胞胞质与肝内胆管上皮细胞中。胆道闭锁引起的胆管系统堵塞会导致过多的GGT在肝脏中不断淤积并进入血液循环。研究显示，GGT与胆道闭锁早期诊断、预后评估有着密切关系。本文对近年来GGT在胆道闭锁中的相关研究进行综述，旨在为其临床应用提供参考。
- Abstract:
- As a common diseases in pediatric surgery,biliary atresia (BA) is difficult for an early diagnosis and has an unsatisfactory prognosis.Gamma-glutamyltransferase (GGT),as a key enzyme involved in glutathione metabolism,is widely found in various tissues of human body.It is located on the external surface of cellular membranes.GGT in liver is mainly located on the cytoplasm of hepatocyte and intrahepatic biliary epithelial cells.Blockage of bile duct system due to BA causes an accumulation of GGT in liver and secretion of excess GGT into circulation.And GGT had a close relationship with early diagnosis and prognosis of BA.Here the relevant researches on GGT in BA hve been reviewed for providing rationales for clinical guidance.
参考文献/References:
1 Baumann U,Ure B.Biliary atresia[J].Clin Res Hepatol Gastroenterol,2012,36(3):257-259.DOI:10.1016/j.clinre.2012.03.017.
2 Asai A,Miethke A,Bezerra JA.Pathogenesis of biliary atresia:defining biology to understand clinical phenotypes[J].Nat Rev Gastroenterol Hepatol,2015,12(6):342-352.DOI:10.1038/nrgastro.2015.74.
3 Song Z,Dong R,Shen Z,et al.Surgical outcome and etiologic heterogeneity of infants with biliary atresia who received Kasai operation less than 60 days after birth:A retrospective study[J].Medicine (Baltimore),2017,96(26):e7267.DOI:10.1097/MD.0000000000007267.
4 Ndrepepa G,Kastrati A.Gamma-glutamyl transferase and cardiovascular disease[J].Ann Transl Med,2016,4(24):481.DOI:10.21037/atm.2016.12.27.
5 Kunutsor SK.Gamma-glutamyltransferase-friend or foe within?[J].Liver Int,2016,36(12):1723-1734.DOI:10.1111/liv.13221.
6 Lieberman MW,Wiseman AL,Shi ZZ,et al.Growth retardation and cysteine deficiency in gamma-glutamyl transpeptidase-deficient mice[J].Proc Natl Acad Sci US A,1996,93(15):7923-7926.DOI:10.1073/pnas.93.15.7923.
7 Rojas E,Valverde M,Kala SV,et al.Accumulation of DNA damage in the organs of mice deficient in gamma-glutamyltranspeptidase[J].Mutat Res,2000,447(2):305-316.DOI:10.1016/S0027-5107(99)00191-8.
8 Luo Z,Shivakumar P,Mourya R,et al.Gene expression signatures associated with survival times of pediatric patients with biliary atresia identify potential therapeutic agents[J].Gastroenterology,2019,157(4):1138-1152.DOI:10.1053/j.gastro.2019.06.017.
9 Cabrera-Abreu JC,Green A.Gamma-glutamyltransferase:value of its measurement in paediatrics[J].Ann Clin Biochem,2002,39(Pt 1):22-25.DOI:10.1258/0004563021901685.
10 Hung PY,Chen CC,Chen WJ,et al.Long-term prognosis of patients with biliary atresia:a 25 year summary[J].J Pediatr Gastroenterol Nutr,2006,42(2):190-195.DOI:10.1097/01.mpg.0000189339.92891.64.
11 Sun S,Chen G,Zheng S,et al.Analysis of clinical parameters that contribute to the misdiagnosis of biliary atresia[J].J Pediatr Surg,2013,48(7):1490-1494.DOI:10.1016/j.jpedsurg.2013.02.034.
12 Robie DK,Overfelt SR,Xie L.Differentiating biliary atresia from other causes of cholestatic jaundice[J].Am Surg,2014,80(9):827-831.
13 Hayashida M,Matsuura T,Kinoshita Y,et al.Parameters that help to differentiate biliary atresia from other diseases[J].Pediatr Int,2017,59(12):1261-1265.DOI:10.1111/ped.13392.
14 Agin M,Tumgor G,Alkan M,et al.Clues to the diagnosis of biliary atresia in neonatal cholestasis[J].Turk J Gastroenterol,2016,27(1):37-41.DOI:10.5152/tjg.2015.150379.
15 El-Guindi MA,Sira MM,Sira AM,et al.Design and validation of a diagnostic score for biliary atresia[J].J Hepatol,2014,61(1):116-123.DOI:10.1016/j.jhep.2014.03.016.
16 Rendon-Macias ME,Villasis-Keever MA,Castaneda-Mucino G,et al.Improvement in accuracy of gamma-glutamyl transferase for differential diagnosis of biliary atresia by correlation with age[J].Turk J Pediatr,2008,50(3):253-259.
17 Liu CS,Chin TW,Wei CF.Value of gamma-glutamyl transpeptidase for early diagnosis of biliary atresia[J].Chinese Medical Journal,1998,61(12):716-720.
18 Chen X,Dong R,Shen Z,et al.Value of gamma-glutamyl transpeptidase for diagnosis of biliary atresia by correlation with age[J].J Pediatr Gastroenterol Nutr,2016,63(3):370-373.DOI:10.1097/MPG.0000000000001168.
19 赵冬莹,何振娟,朱建幸,等.血清总胆汁酸联合γ谷氨酰转肽酶检测在评估延迟性黄疸病因中的价值[J].上海交通大学学报(医学版),2013,33(7):931-935.DOI:10.3969/j.issn.1674-8115.2013.07.007. Zhao DY,He ZJ,Zhu JX,et al.Value of serum total bile acid and γ-glutamyl-transferase in etiological diagnosis of prolonged jaundice[J].Journal of Shanghai Jiaotong university (Medicine),2013,33(7):931-935.DOI:10.3969/j.issn.1674-8115.2013.07.007.
20 储波,蒋丽蓉,周莎,等.肝功能检查在婴儿肝炎综合征和先天性胆道闭锁的鉴别诊断中的价值[J].中国当代儿科杂志,2009,11(12):953-956. Chu B,Jiang LR,Zhou S,et al.Value of the liver function test in differential diagnosis of infantile hepatitis syndrome and biliary atresia[J].Chinese Journal of Contemporary Pediatrics,2009,11(12):953-956.
21 El-Guindi MA,El-Said HH,Hussein MH,et al.Urinary urobilinogen in biliary atresia:A missed,simple and cheap diagnostic test[J].Hepatol Res,2016,46(2):174-182.DOI:10.1111/hepr.12558.
22 付海燕,赵瑞芹,白革兰,等.血清γ-谷氨酰转肽酶联合直接胆红素诊断婴儿胆道闭锁的价值[J].中国当代儿科杂志,2019,21(12):1198-1202.DOI:10.7499/j.issn.1008-8830.2019.12.009. Fu HY,Zhao RQ,Bai GL,et al.Value of serum gamma-glutamyl transpeptidase plus direct bilirubin in the diagnosis of biliary atresia in infants[J].Chinese Journal of Contemporary Pediatrics,2019,21(12):1198-1202.DOI:10.7499/j.issn.1008-8830.2019.12.009.
23 Tang KS,Huang LT,Huang YH,et al.Gamma-glutamyl transferase in the diagnosis of biliary atresia[J].Acta Paediatr Taiwan,2007,48(4):196-200.
24 Dong R,Jiang J,Zhang S,et al.Development and validation of novel diagnostic models for biliary atresia in a large cohort of Chinese patients[J].EBioMedicine,2018,34:223-230.DOI:10.1016/j.ebiom.2018.07.025.
25 Dong R,Dong K,Wang X,et al.Interleukin-33 overexpression is associated with gamma-glutamyl transferase in biliary atresia[J].Cytokine,2013,61(2):433-437.DOI:10.1016/j.cyto.2012.10.035.
26 Chen PS,Zhong ZH,Jiang H,et al.Th17-associated cytokines multiplex testing indicates the potential of macrophage inflammatory protein-3 alpha in the diagnosis of biliary atresia[J].Cytokine,2019,116:21-26.DOI:10.1016/j.cyto.2019.01.002.
27 Yang L,Zhou Y,Xu PP,et al.Diagnostic accuracy of serum matrix metalloproteinase-7 for biliary atresia[J].Hepatology,2018,68(6):2069-2077.DOI:10.1002/hep.30234.
28 Jiang JY,Wang JF,Shen Z,et al.Serum MMP-7 in the diagnosis of biliary atresia[J].Pediatrics,2019,144(5):e20190902.DOI:10.1542/peds.2019-0902.
29 Arora NK,Kohli R,Gupta DK,et al.Hepatic technetium-99m-mebrofenin iminodiacetate scans and serum gamma-glutamyl transpeptidase levels interpreted in series to differentiate between extrahepatic biliary atresia and neonatal hepatitis[J].Acta Paediatr,2001,90(9):975-981.DOI:10.1080/080352501316978039.
30 Dillman JR,Dipaola FW,Smith SJ,et al.Prospective assessment of ultrasound shear wave elastography for discriminating biliary atresia from other causes of neonatal cholestasis[J].J Pediatr,2019,212:60-65.e3.DOI:10.1016/j.jpeds.2019.05.048.
31 Sun S,Zheng S,Lu XX,et al.Clinical and pathological features of patients with biliary atresia who survived for more than 5 years with native liver[J].Pediatr Surg Int,2018,34(4):381-386.DOI:10.1007/s00383-018-4231-7.
32 Shankar S,Bolia R,Foo HW,et al.Normal gamma glutamyl transferase levels at presentation predict poor outcome in biliary atresia[J].J Pediatr Gastroenterol Nutr,2020,70(3):350-355.DOI:10.1097/MPG.0000000000002563.
33 Wang ZM,Chen YJ,Peng CH,et al.Five-year native liver survival analysis in biliary atresia from a single large Chinese center:The death/liver transplantation hazard change and the importance of rapid early clearance of jaundice[J].J Pediatr Surg,2019,54(8):1680-1685.DOI:10.1016/j.jpedsurg.2018.09.025.
34 Koga H,Wada M,Nakamura H,et al.Factors influencing jaundice-free survival with the native liver in post-portoenterostomy biliary atresia patients:results from a single institution[J].J Pediatr Surg,2013,48(12):2368-2372.DOI:10.1016/j.jpedsurg.2013.08.007.
35 Gupta L,Gupta SD,Bhatnagar V.Extrahepatic biliary atresia:Correlation of histopathology and liver function tests with surgical outcomes[J].J Indian Assoc Pediatr Surg,2012,17(4):147-152.DOI:10.4103/0971-9261.102326.
36 Goda T,Kawahara H,Kubota A,et al.The most reliable early predictors of outcome in patients with biliary atresia after Kasai’s operation[J].J Pediatr Surg,2013,48(12):2373-2377.DOI:10.1016/j.jpedsurg.2013.08.009.
37 Freeman AJ,Ng VL,Harpavat S,et al.Level of gamma-glutamyltransferase in 2-year-old children with biliary atresia associates with progression of portal hypertension[J].Clin Gastroenterol Hepatol,2017,15(7):1133-1135.DOI:10.1016/j.cgh.2017.02.025.
38 Squires JE,Ng VL,Hawthorne K,et al.Neurodevelopmental outcomes in preschool and school aged children with biliary atresia and their native liver[J].J Pediatr Gastroenterol Nutr,2020,70(1):79-86.DOI:10.1097/MPG.0000000000002489.
相似文献/References:
[1]施佳邬文杰蔡威.78例胆道闭锁患儿诊疗与近期随访分析[J].临床小儿外科杂志,2010,9(03):0.
SHI Jia,WU Wen-jie,PAN Wei-hua,et al.Clinical treatment and short term fllow-up biliary atresia.[J].Journal of Clinical Pediatric Surgery,2010,9(02):0.
[2]姚桃月,段星星,周梦洁,等.超声剪切波弹性成像联合血液生化指标对胆道闭锁的诊断价值[J].临床小儿外科杂志,2021,20(02):119.[doi:10.12260/lcxewkzz.2021.02.004]
Yao Taoyue,Duan Xingxing,Zhou Mengjie,et al.Diagnostic value of ultrasonic shear wave elastography plus blood biochemical indicators for biliary atresia[J].Journal of Clinical Pediatric Surgery,2021,20(02):119.[doi:10.12260/lcxewkzz.2021.02.004]
[3]姜璟?,具钊汝,孙颖华,等.剪切波弹性成像诊断胆道闭锁价值的Meta分析[J].临床小儿外科杂志,2021,20(02):126.[doi:10.12260/lcxewkzz.2021.02.005]
Jiang Jingying,Ju Zhaoru,Sun Yinghua,et al.Application of shear wave elastography for diagnosing biliary atresia: a Meta-analysis[J].Journal of Clinical Pediatric Surgery,2021,20(02):126.[doi:10.12260/lcxewkzz.2021.02.005]
[4]丁彩琳,陈亚军.二维剪切波弹性成像在胆道闭锁中的研究进展[J].临床小儿外科杂志,2022,21(06):571.[doi:10.3760/cma.j.cn101785-202011032-014]
Ding Cailin,Chen Yajun.Overview of two-dimensional shear wave elastography in biliary atresia[J].Journal of Clinical Pediatric Surgery,2022,21(02):571.[doi:10.3760/cma.j.cn101785-202011032-014]
[5]徐琛,汤悦,郑珊,等.Kasai术中肝脏吲哚菁绿显像特点与胆道闭锁患儿早期预后的关系探索[J].临床小儿外科杂志,2022,21(08):738.[doi:10.3760/cma.j.cn101785-202111058-007]
Xu Chen,Tang Yue,Zheng shan,et al.Study of real-time imaging with indocyanine green during hepatoportoenterostomy as a prognostic factor in children with biliary atresia[J].Journal of Clinical Pediatric Surgery,2022,21(02):738.[doi:10.3760/cma.j.cn101785-202111058-007]
备注/Memo
收稿日期:2019-12-02。
基金项目:国家自然科学基金（编号：81974059）
通讯作者:郑珊,Email:szheng@shmu.edu.cn