嬰兒大便卡在台灣之全國性篩檢膽道閉鎖兒的研究

Universal Screening for Biliary Atresia Using an Infant Stool Color Card in Taiwan

蕭正輝(Cheng-Hui Hsiao)

指導教授 ： 張美惠

共同指導教授 ： 倪衍玄(Yen-Hsuan Ni)

國立臺灣大學/醫學院/臨床醫學研究所/碩士(2008年)

https://doi.org/10.6342/NTU.2008.01124

摘要

研究背景：膽道閉鎖是兒童肝病最常見的死亡原因。雖然病童在出生60天內接受葛西手術能顯著地改善這些病童的預後，但是由於對膽道閉鎖與常見的良性延長性黃疸之鑑別診斷缺乏認知，膽道閉鎖病童的延遲轉診及延遲手術治療，仍是一個全球性的重要問題。

目的：利用嬰兒大便顏色卡，建立一個膽道閉鎖全國性篩檢系統，以促成膽道閉鎖的早期診斷及治療。

方法：從西元2002-2003年，我們已陸續在台灣的北中南東四區共95家醫療院所，完成嬰兒大便顏色卡的區域篩檢。我們設計的嬰兒大便顏色卡，內含1~6號共六種不同大便顏色的照片。從西元2004年起，嬰兒大便顏色卡已經全面性放入兒童健康手冊內，嬰兒大便顏色卡的全國性篩檢就此展開。一旦家屬或醫護人員發現如卡片所示1~3號異常大便顏色，需在24小時內以電話或傳真通報大便卡諮詢中心。本研究的篩檢對象，是西元2004年至2005年出生於台灣的全國新生嬰兒，共計422,273名。此外，回溯性分析西元1976年至2000年，在台大醫院住院且追蹤超過一歲的膽道閉鎖病童，以比較嬰兒大便顏色卡篩檢前後的差異。

結果：西元2004年及2005年之膽道閉鎖的年發生率，分別為每一萬名活產嬰兒數中1.85（40/216,419）及1.70（35/205,854）。利用嬰兒大便顏色卡於出生60天內篩檢出膽道閉鎖的敏感度，由2004年的72.5％，進步至2005年的97.1%。全國膽道閉鎖嬰兒於出生60天內接受葛西手術的比率，由2004年的60%，進步到2005年的74.3%，且西元2005年於出生60天內手術的比率顯著地高於西元1976-2000年的47.2％（68/144, P值為0.004）。在西元2004-2005年的膽道閉鎖病童，於葛西手術後三個月的黃疸消退率（血清總膽紅素值＜2 mg/ dL）為59.5％（44/74），顯著地高於嬰兒大便顏色卡篩檢前於西元1976-2000年的37.0％（50/135, P值為0.002）。

結論：利用嬰兒大便顏色卡全面性的篩檢新生兒，有助於膽道閉鎖病童的早期轉診，進而提升及時葛西手術的比率，以及較佳的手術預後。

關鍵字

膽道閉鎖 ； 嬰兒大便顏色卡 ； 篩檢 ； 發生率 ； 葛西手術

並列摘要

BACKGROUND: Biliary atresia is the most common cause of death from liver disease in children. Although the Kasai operation before 60 days of age can significantly improve prognosis, delay in referral and surgery remains a formidable problem worldwide because of difficulties in differentiating it from benign prolonged neonatal jaundice.

AIMS: To establish a universal screening system using an infant stool color card to promote the early diagnosis and treatment of biliary atresia.

SUBJECTS AND METHODS: After a pilot regional study in 2002-2003, a national stool color screening system was established by integrating the infant stool color card into the child health booklet given to every neonate in Taiwan since 2004. Within 24 hours of the discovery of an abnormal stool color, this event is reported to the registry center. Our participants included 422,273 neonates who were born in 2004-2005 in Taiwan. Furthermore, we retrospectively reviewed the medical records of infants with biliary atresia who were admitted to the National Taiwan University Hospital from January 1976 to December 2000, but excluding those infants lost to follow-up before 1 year of age.

RESULTS: The annual incidence of biliary atresia per 10,000 live births in 2004 and 2005 was 1.85 (40/216,419) and 1.70 (35/205,854), respectively. The sensitivity of detecting biliary atresia using stool cards before 60 days of age was 72.5% in 2004, which improved to 97.1% in 2005. The national rate of the Kasai operation before 60 days of age increased from 60% in 2004 to 74.3% in 2005, which was significantly higher than the historical data of 47.2% in 1976-2000 (68/144, P=0.004). The jaundice-free rate (<2 mg/dL) at 3 months after the Kasai operation among infants with biliary atresia in 2004-2005 was 59.5% (44/74), significantly higher than the historical data of 37.0% in 1976-2000 before the stool card screening program (50/135, P=0.002).

CONCLUSION: Universal screening using the stool color cards can enhance earlier referral, which may ultimately lead to timely performance of the Kasai operation and better postoperative outcome in infants with biliary atresia.

並列關鍵字

biliary atresia ； infant stool color card ； screening ； incidence ； Kasai operation

參考文獻

1. Otte JB, Goyet J, Reding R, Hausleithner V, Sokal E, Chardot C, et al. Sequential treatment of biliary atresia with Kasai portoenterostomy and liver transplantation: a review. Hepatology 1994; 20(suppl): 41S-48S.

3. Davenport M, de Goyet J DV, Stringer MD, Mieli-Vergani G, Kelly DA, McClean P, et al. Seamless management of biliary atresia in England and Wales (1999-2002). Lancet 2004; 363: 1354-1357.

4. Nio M, Ohi R, Miyano T, Saeki M, Shiraki K, Tanaka K. Five- and 10- year survival rates after surgery for biliary atresia: a report from the Japanese biliary atresia registry. J. Pediatr Surg 2003; 38: 997-1000.

5. Shim WK, Kasai M, Spence MA. Racial influence on the incidence of biliary atresia. Prog Pediatr Surg 1974; 6: 53-62.

6. Chardot C, Carton M, Spire-Bendelac N, Pommelet CL, Golmard JL, Auvert B. Epidemiology of biliary atresia in France : a national study 1986-96. J Hepatol 1999; 31: 1006-1013.