血清总胆汁酸及酶学指标在鉴别诊断肝病患者中的应用分析

Study on application of serum total bile acid and enzymatic indices in differential diagnosis of patients with liver diseases

目的探讨血清总胆汁酸(TBA)及酶学指标[天门冬氨酸氨基转氨酶(AST)、丙氨酸氨基转氨酶(ALT)、γ谷氨酰转肽酶(GCT)、碱性磷酸酶(ALP)]在鉴别不同病情肝病患者中的应用价值及其相互关系。方法采用日立7020全自动化生化分析仪测定68例慢性病毒性肝炎(CVH组)、72例急性病毒性肝炎(AVH组)、60例酒精性肝炎(AH组)、58例肝炎型肝硬化(HLC组)、50例原发性肝癌组(HCC组)及70例健康体检者(对照组)血清TBA、AST、ALT、GCT、ALP水平。采用受试者工作特征曲线(ROC)分析TBA、AST、ALT、GCT、ALP在鉴别不同类型肝病中的应用价值。结果 CVH组、AVH组、AH组、HLC组、HCC组血清TBA、AST、ALT、GCT、ALP水平均高于对照组(P<0.05)。其中TBA在AVH组中升幅最大,AST、ALT、GCT、ALP在HCC组中升幅最大。对血清TBA及各项肝酶学指标绘制不同肝病分组的ROC曲线,结果显示,在CVH组、AVH组中血清TBA、AST、ALT、GCT、ALP的AUC均大于0.8,而TBA、AST在HLC组、HCC组中AUC大于0.8,所有指标在AH组中临床意义不大。经Peason相关因素分析显示,TBA与AST呈正相关(P<0.05),而与ALT、GCT、ALP无相关性(P>0.05)。结论 TBA、AST、ALT、GCT、ALP在CVH组、AVH组中均有较高的诊断意义,而TBA、AST在HCC组、HLC组中具有较高诊断意义,所有指标对AH组诊断意义较低。TBA、AST联合检测或可能更全面准确评价肝病。

Objective To explore the application of serum total bile acid（ TBA） and enzymatic indices as aspartate aminotransferase（ AST）,alanine aminotransferase（ ALT）,γ- glutamyl endopeptidase（ GCT） and alkaline phosphatase（ ALP） in differential diagnosis of patients with liver diseases. Methods Serum levels of TBA,AST,ALT,GCT and ALP were examined by Hitach 7020 automatic biochemical analyzer by using specific curve（ ROC） in 68 patients with chronic viral hepatitis（ CVH group）,72 patients with acute viral hepatitis（ AVH group）,60 patients with alcoholic hepatitis（ AH group）,58 patients with cirrhosis caused by hepatitis（ HLC group）,50 patients with primary liver cancer（ HCC group） and 70 healthy volunteers（ control group）. Results Serum levels of TBA,AST,ALT,GCT and ALP in CVH group,AVH group,AH group,HLC group and HCC groups were higher than those of control group（ P〈0. 05）. The largest increment of serum level of TBA was seen in AVH group,the largest increment in levels of AST,ALT,OCT and ALP had been seen in HCC group. Of ROC curve plotted by serum TBA and serum liver enzyme indicators with different liver packets showed that AUC of serum levels of TBA,AST,ALT,GCT and ALP in CVH and AVH groups was greater than 0. 8,and AUC of TBA and AST in HLC group and HCC group was also greater than 0. 8,and the clinical significance of all indicators of GCT in AH group was not significant. Pearson correlation analysis showed that serum level of TBA was positively correlated with level of AST（ P〈0. 05）,but there was no correlation with serum levels of ALT,GCT and ALP（ P〈0. 05）. Conclusion Serum levels of TBA,AST,ALT,GCT and ALP have higher diagnostic significance in CVH group and AVH group,and serum levels of TBA and AST have higher diagnostic significance in HCC group and HLC group. The diagnostic significance of all indicators in AH group is low. The joint detection of serum levels of TBA and AST may be more comprehensive and accurate in evaluation of liver diseases.