血清Hcy与多项肝酶学指标在肝病中的临床应用价值

Clinical Applicative Value of Determination on Serum Homocysteine and Liver Enzymes in Liver Disease

目的:了解同型半胱氨酸(Hcy)与α-岩藻糖苷酶(AFU)、天冬氨酸氨基转移同工酶(ASTm)、谷氨酸脱氢酶(GLDH)、腺苷脱氨酶(ADA)、血清天冬氨酸转氨基酶(AST)、丙氨酸转氨基酶(ALT)、γ-谷氨酰转肽酶(GGT)和5’-核苷酸酶(5’-NT)等肝酶学指标在肝病诊断中的价值。方法:分别采用酶联免疫吸附试验(ELISA)和全自动生化分析仪对Hcy及上述肝酶学指标在356例各种肝病患者和115例正常人血清中的变化进行检测和分析。结果:急性病毒性肝炎时Hcy、AFU、ASTm、GLDH、ADA、AST、ALT、GGT和5’-NT均显著增高,ALT、AFU、ASTm和AST的ROC曲线下面积(AUC)分别为0.875、0.853、0.830和0.825,阳性率分别为100%、78.9%、87.8%和97.8%;肝炎肝硬化时Hcy、ASTm、GLDH、ADA、AST、GGT和5’-NT均显著升高,胆碱酯酶(CHE)显著降低,ADA、AST、5’-NT、GGT和CHE的AUC分别为0.764、0.761、0.752、0.748和0.721,阳性率分别为90.1%、73.2%、67.6%、76.1%和62.0%;重型病毒性肝炎时Hcy、AFU、ASTm、GLDH、ADA、AST、ALT、GGT和5’-NT均显著增高,CHE显著降低,AST、ALT、ASTm、CHE、AFU、GLDH和Hcy的AUC分别为0.876、0.840、0.792、0.792、0.751、0.729和0.725,阳性率分别为100%、100%、93.6%、100%、72.3%、91.5%和100%;原发性肝癌时Hcy、AFU、ASTm、GLDH、ADA、AST、GGT和5’-NT均显著升高,CHE显著降低,AFU、5’-NT和GGT的AUC分别为0.822、0.814和0.811,阳性率分别为90.9%、86.4%和97.7%。肝病患者血清Hcy与CHE活性呈显著负相关(r=-0.36,P<0.01)。结论:对急性病毒性肝炎诊断意义较大的指标为ALT、AFU、ASTm和AST;对肝炎后肝硬化诊断意义较大的指标为ADA、AST、5’-NT、GGT和CHE;对重型病毒性肝炎诊断意义较大的指标为AST、ALT、ASTm、CHE、AFU、GLDH和Hcy;对原发性肝癌诊断意义较大的指标为AFU、5’-NT和GGT;所有指标对慢性病毒性肝炎和酒精型肝炎的临床意义都较低。Hcy和CHE的联检或可更有助于全面准确地评估肝病患者肝损害的程度。

Objective To evaluate the diagnostic value of the examination on homocysteine and liver enzymes in patients suffer- ing from liver diseases. Methods Serum level of Hcy was measured with ELISA and serum levels of AFU, ASTm, GLDH, ADA, AST,ALT, GGT,5＇-NT and CHE were detected by autobiochemical analyzer in 356 hepatitis patients and 115 healthy subjects served as normal control. Results In patients with acute viral hepatitis, the mean values of Hcy,AFU,ASTm,GLDH,ADA,AST,ALT,GGT and 5＇-NT increased significantly compared with healthy subjects, AUCs of ALT,AFU,ASTm and AST were 0. 875,0. 853, 0. 830 and 0.825 respectively, and positive rates of ALT,AFU,ASTm and AST were 100% ,78.9% ,87.8% and 97.8% respectively. In patients with hepatitis and liver cirrhosis, the mean values of Hcy, ASTm, GLDH, ADA, AST, GGT and 5＇-NT increased significantly while that of CHE decreased significantly compared with controls. AUCs of ADA, AST, 5＇-NT, GGT and CHE were 0. 764,0. 761,0. 752,0. 748 and 0.721 individually, and positive rates of ADA,AST,5＇-NT,GGT and CHE showed 90.1% ,73.2% ,67.6% ,76.1% and 62.0% separtately. In patients with severe viral hepatitis, the mean values of Hcy, AFU, ASTm, GLDH, ADA, AST, ALT, GGT and 5＇-NT in-creased significantly while that of CHE decreased significantly compared with cantrol. AUCs of AST, ALT, ASTm, CHE, AFU,GLDH and Hcy proved 0. 876 ,0. 840 ,0. 792 ,0. 792 ,0. 751, 0. 729 and 0.725 respectively, and positive rates of AST,ALT,ASTm, CHE, AFU,GLDH and Hcy expressed 100%, 100% ,93.6%, 100% ,72.3% ,91.5% and 100% respectively. In patients with hepatocellular carcinoma, the mean values of Hcy, AFU, ASTm, GLDH, ADA, AST, GGT and 5＇-NT increased obvieusly while that of CHE decreased markedly compared fo the control, AUCs of AFU,5＇-NT and GGT presented 0. 822,0. 814 and 0.811 and positive rates of AFU,5＇-NT and GGT showed 90.9%, 85.4% and 97.7%. Serum level of Hcy was inversely correlated with serum level of CHE in all patients with liver disease （n = 356, r = - 0.36, P 〈 0.01 ）. Conclusion ALT, AFU, ASTm and AST are valuable markers for diagnosing of a- cute viraual hepatitis, ADA,AST,5＇-NT,GGT and CHE are valuable marker for diagnosing of posthepatitis liver cirrhosis, AST,ALT, ASTm,CHE,AFU,GLDH and Hcy are valuable marker for diagnosing of severe viral hepatitis,and AFU,5＇-NT and GGT are valuable markers for diagnosing of hepatocellular carcinoma. All items are less valuable for diagnosing of chronic viral hepatitis and alcoholic hepatitis. Combined analysis of Hcy and CHE might be helpful to evaluate the severity of liver impairment more accurately in patients with liver disease.