12项肝酶学指标对肝病诊断的临床价值研究

Study on diagnostic value of determination of liver enzymology in liver disease

目的了解N-乙酰-β-D氨基葡萄糖苷酶(NAG)、α-岩藻糖苷酶(AFU)、亮氨酸氨基肽酶(LAP)、天门冬氨酸氨基转移同工酶(ASTm)、谷氨酸脱氢酶(GLDH)、腺苷脱氨酶(ADA)、血清天门冬氨酸转氨基酶(AST)、丙氨酸转氨基酶(ALT)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(GGT)、5′-核苷酸酶(5′-NT)及血清胆碱酯酶(CHE)等12项肝酶学指标在肝病诊断和治疗中的价值。方法采用全自动生化分析仪对308例各种肝病患者和115例健康人血清中的上述指标进行检测和分析。结果急性肝炎时NAG、AFU、LAP、ASTm、GLDH、ADA、AST、ALT、ALP、GGT和5′-NT均显著增高,肝硬化时NAG、LAP、ASTm、GLDH、ADA、AST、ALP、GGT和5′-NT均显著升高,CHE显著降低;重型肝炎时NAG、AFU、ASTm、GLDH、ADA、AST、ALT、ALP、GGT和5′-NT均显著增高,CHE显著降低;原发性肝癌时NAG、AFU、LAP、ASTm、GLDH、ADA、AST、ALP、GGT和5′-NT均显著升高,CHE显著降低。结论对急性肝炎诊断意义较大的指标为ALT、LAP、AFU、ASTm、AST和ALP;对肝硬化诊断意义较大的指标为ADA、AST、5′-NT、GGT和CHE;对重型肝炎诊断意义较大的指标为AST、ALT、ASTm、CHE、AFU和GLDH;对原发性肝癌诊断意义较大的指标为AFU、5′-NT、GGT、ALP和LAP;12项指标对慢性肝炎和酒精型肝炎的临床意义都较低。

Objective To evaluate the diagnostic value for the examination of liver enzymology in the patients suffering from liver diseases. Methods Serum values of NAG,AFU,LAP,ASTm,GLDH,ADA,AST,ALT,ALP, GGT,5＇-NT and CHE were determined with auto-biochemical analyzer and analyzed statistically in 308 hepatitis patients and 115 healthy subjects. Results In acute hepatitis patients, the mean values of NAG, AFU, LAP, ASTm, GLDH,ADA,AST, ALT, ALP,GGT and 5＇-NT increased significantly compared with healthy subjects. In liver cirrhosis patients,the mean values of NAG, LAP, ASTm, GLDH, ADA, AST, ALP, GGT and 5＇-NT increased significantly while that of CHE decreased significantly compared with healthy subjects. In severe hepatitis patients, the mean values of NAG, AFU, ASTm, GLDH, ADA, AST, ALT, ALP, GGT and 5＇-NT increased significantly while that of CHE decreased significantly compared with healthy subjects. In hepatoeellular carcinoma, the mean values of NAG,AFU,LAP, ASTm,GLDH, ADA, AST, ALP, GGT and 5＇-NT increased significantly while that of CHE decreased significantly compared with healthy subjects. Conclusion ALT,LAP,AFU,ASTm,AST and ALP are valuable markers for diagnosing acute hepatitis, ADA, AST, 5＇-NT, GGT and CHE are valuable marker for diagnosing liver cirrhosis, AST, ALT, ASTm, CHE, AFU and GLDH are valuable marker for diagnosing severe hepatitis, and AFU,5＇-NT,GGT,ALP and LAP are valuable markers for diagnosing hepatocellular carcinoma. All items are less valuable for diagnosing chronic hepatitis and alcoholic hepatitis.