Abstract
Objective To explore the changing serum trends of gamma-glutamyl transferase (GGT), clinical features and prognosis of biliary atresia (BA) patients with preoperative low GGT level. Methods From 2012 to 2014, selected patients were divided into 3 groups of L (n=61, GGT: 47-150 IU/L), M (n=48, GGT: 150-1000 IU/L) and H (n=85, GGT: 1000-2433 IU/L). The changes of GGT and enzymes were observed pre-operation and at 1, 3, 6 months post-operation respectively. Persistent jaundice within one year, liver transplantation, mortality or lost to follow-up were defined as poor prognosis; jaundice subsided within 1 year and survival with native liver were defined as good prognosis. Results The mean age of BA children with low preoperative GGT (115.7±26.6 IU/L) was 60.6±13.4 days, accounting for 7.3% (61/830). At Month 1 after Kasai operation, GGT increased sharply in good prognosis group (GPG) and bad prognosis group (BPG). And elevated GGT value was higher in GPG than that in BPG (P<0.001). At Month 3, GGT began to decrease in GPG while it continued rising in BPG. In group M, the mean age was 65.3±21.7 days and the mean preoperative GGT was 535.5±222.6 IU/L. At Month 1 post-operation, the GGT level increased both in GPG and BPG (P<0.05). However, no significant difference existed in elevated value. In group H, the mean age was 70.0±20.0 days and the mean GGT 1496.5±446.4 IU/L. At Month 1 post-operation, the level of GGT decreased significantly in both GPG and BPG (P=0.014). The preoperative levels of ALT, AST and DBIL were higher in group L than those in another two groups. Conclusions Children with low GGT can not be excluded by the diagnosis of BA independently. High levels of liver enzymes and bilirubin hint at a better prognosis if GGT increases rapidly at Month 1 post-operation and subsequently decreases gradually. Children with high preoperative GGT may have a better prognosis than those with low/medium GGT. And the prognosis of those with medium preoperative GGT level is the worst. Key words: Biliary atresia; Gamma-glutamyltransferase; Prognosis
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