The Clinicopathological Parameters for Making the Differential Diagnosis of Neonatal Cholestasis
이희진, 강준, 김경모, 장주영, 장세진, 유은실,
소속 상세정보
이희진 ( Lee Hee-Jin )
울산대학교 의과대학 서울아산병원 병리학교실
강준 ( Kang Jun )
울산대학교 의과대학 서울아산병원 병리과
김경모 ( Kim Kyung-Mo )
울산대학교 의과대학 서울아산병원 소아과학교실
장주영 ( Jang Joo-Young )
울산대학교 의과대학 서울아산병원 소아과학교실
장세진 ( Jang Se-Jin )
울산대학교 의과대학 서울아산병원 병리학교실
유은실 ( Yu Eun-Sil )
울산대학교 의과대학 서울아산병원 병리학교실
KMID : 0357920090430010043
Abstract
Background: The diseases that cause neonatal cholestasis display several overlapping clinical feature. Making the differential diagnosis using liver biopsy specimens from infants with neonatal cholestasis is important for delivering the proper treatment.
Methods: We assessed the clinical manifestations, laboratory data, and histopathologic features of the pretreatment liver biopsy specimens from patients suffering with biliary atresia (n=66), intrahepatic bile duct paucity (n=15), and neonatal hepatitis (n=21).
Results: The gender distribution was nearly equal for the patients with biliary atresia and intrahepatic bile duct paucity, whereas males predominated for the cases of neonatal hepatitis. Only the gamma-glutamyl transferase level differed significantly amongst the groups. The diagnostic features for making the differentialdiagnosis of bile duct lesions included marked bile ductular proliferation, severe fibrosis, and bile duct loss. The difference of the average percentage of portal tracts with bile duct loss was statistically significant between the patients with intrahepatic bile duct paucity (73.9%) and those patients with neonatal hepatitis (39.1%) (p<0.001).
Conclusions: Bile ductular proliferation, bile duct loss, and advanced fibrosis are useful for the differential diagnosis of neonatal cholestasis. Moreover, stricter diagnostic criteria for bile duct loss (more than 2/3 of bile ducts) should be applied for the definitive diagnosis of intrahepatic bile duct paucity, because bile duct loss also frequently occurs in infants suffering with neonatal hepatitis.
키워드
Neonate;Cholestasis;Biliary atresia;Hepatitis;Intrahepatic bile ducts
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