Issn Print: 0277-2116

Publication Date: 2004/06/01


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P0215 HYALURONAN: A USEFUL BIOCHEMICAL MARKER IN DIAGNOSIS OF BILIARY ATRESIA

N. Ukarapol; L. Wongsawasdi; S. Ong-Chai; P. Riddhiputra; P. Kongtawelert

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Author Information: Pediatrics,

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Introduction: Despite extensive study, there has been no single non-invasive investigation that could have precisely made a diagnosis of biliary atresia (BA). Therefore, serum hyaluronan (HA), a high-molecular-weight glycosaminoglycan produced and present in the extracellular matrix and principally degraded by hepatic sinusoids, was evaluated in this study as a profile of liver function test for diagnosis of neonatal cholestasis.
Methods: From August, 2002 to June, 2003, all infants with neonatal jaundice were prospectively enrolled. Demographic and clinical data were recorded. Routine biochemical tests and serology for TORCHS infections were carried out. An ultrasonography, HIDA scan and percutaneous/open liver biopsy were also performed. The patient was diagnosed as BA if either operative findings of atretic common bile duct/gallbladder or evidence of bile duct obstruction demonstrated by intraoperative cholangiography was noted. Serum HA was measured at the diagnosis using ELISA-based assay.
Results: A total of 25 patients with the diagnosis of BA (n=10), neonatal hepatitis (NH) (n=9), choledochal cyst (n=3) and TPN-induced cholestasis (n=3), were studied. The age at diagnosis was not significantly different between groups, with the mean age of 103.6 +/− 69.9 days. The serum HA was significantly elevated in BA (median of 513.6 ng/ml, ranged 19–4475.7) compared to NH (median of 49.6 ng/ml, ranged 19–315.1) (p=0.03). But, the value was comparable in hepatocellular diseases (NH vs. TPN-induced cholestasis). In the patients with choledochal cyst, on contrary, it was significantly much higher (mean of 2119.1 +/− 1021.6 ng/ml). There was no significant correlation between serum HA, gamma-glutamyl transferase and alkaline phosphatase.
Conclusion: HA is a useful serum marker to differentiate biliary tract diseases, particularly choledochal cyst and BA, from hepatocellular diseases (NH). Because it is simple, reliable and reproducible assay, serum HA should be considered as one of the routine liver profile for evaluating infants with neonatal cholestasis.
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