尿氨基己糖苷酶对乙醇性肝病的诊断

Urinary Beta-hexosaminidase,A Biochemical Marker of Alcoholic Liver Disease

目的:检测乙醇性肝病(ALD)患者尿氨基己糖苷酶(uHex),并与血清中的%缺糖基转铁蛋白(%CDT)与总转铁蛋白(Tf)的比值、γ-谷氨酰转移酶(GGT)、平均红细胞容积(MCV)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)等指标比较,评价其对ALD的诊断价值。方法:选择健康不饮酒对照组、非乙醇性肝病的其他肝病组(NALD组)、ALD组(三组均为男性),分别检测uHex,%CDT,GGT,MCV,ALT,AST等指标,各指标在不同组间的比较用F检验;各项目之间的关系研究用直线相关,计算相关系数;同时绘制各指标的ROC曲线。结果:ALD组中的uHex显著高于对照组,但与NALD组无显著性差异。uHex诊断ALD的ROC曲线下面积为0.737,敏感度为0.60,特异度为0.76,而%CDT这三者分别为0.857,0.75,0.88,GGT分别为0.751,0.75,0.76,MCV分别为为0.669,0.30,0.78,ALT分别为为0.512,0.25,0.72,AST分别为为0.426,0.25,0.68。uHex与%CDT,GGT不相关,与这两者联合检测敏感度提高到1,0.9。结论:对于ALD的诊断,uHex,%CDT,GGT和MCV均具有一定的诊断价值,尤其%CDT是一个很好的辅助诊断指标,uHex也不失为一个较好的非损伤性的指标。uHex与%CDT,GGT联用可提高敏感度。

Objective： To evaluate the diagnostic value of urinary beta-hexosaminidase（uHex） for alco holic liver disease（ALD） in contrast to the ratio of carbohydrate-deficient transferrin to total transferrin （% CDT） , gamma-glutamyltransferase （GGT） , mean corpuscular volume （ MCV ） , alanine aminotransferase （ALT） , aspartate aminotransferase （AST）. Methods ： The uHex, % CDT, GGT, MCV, ALT and AST of sera of 20 cases with ALD were determined,and 30 healthy nondrinkers, 20 non-alcohol-related liver diseases （NALD） also determined simultaneously. Results： The area under the ROC curve of % uHex, CDT, GGT,MCV,ALT and AST were 0. 737,0. 857,0.751,0.669,0.512 and 0.426, the diagnostic sensitivity were 0. 60,0. 75,0. 75, 0.30, 0.25 and 0.25 ,and the diagnostic specificity were 0. 76,0. 88 ,0. 76,0. 78 , 0.72 and 0.68 respectively, uHex was not correlative with % CDT and GGT so we combined uHex with % CDT and GGT（either one positive） to rise the clinical sensitivity for diagnosis of ALD. Conclusion： The results indicated that % CDT was one of the best markers for ALD. uHex was a good marker too.