肝脏传统实验室指标和二唾液酸联合检测对酒精性肝病的临床价值研究

Research on the Clinical Value of Liver Traditional Laboratory Indexes and Dual Sialic Acid Joint Detection on Alcoholic Liver Disease

目的:探讨肝脏传统实验室指标〔丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT)、平均红细胞体积(MCV)〕和糖缺失性转铁蛋白亚型二唾液酸百分含量(%DST)在酒精性肝病(ALD)中的诊断价值。方法:将我院2014年6月—2015年6月收治的30例明确诊断为ALD和30例非酒精性肝病(NAFLD)及30例体检健康者血清ALT、AST、GGT、MCV和%DST水平,分别分析检测诊断ALD的受试者工作曲线下面积(ROC-AUC)、敏感度和特异性。结果:ALD组血清%DST和GGT曲线下面积,敏感度和特异性均高于NAFLD组和健康对照组(%DSTAUC=0.940、敏感度90.0%、特异性90.3%、P<0.001;GGTAUC=0.766、敏感度76.7%、特异性77.4%、P<0.001;ALTAUC=0.502、敏感度50.0%、特异性61.3%、P<0.001;ASTAUC=0.345、敏感度33.3%、特异性71.0%,P=0.433;MCVAUC=0.546、敏感度43.3%、特异性77.4%,P=1.000)。%DST和GGT对ALD有显著性差异(均P<0.001),%DST诊断ALD的敏感度高于GGT,%DST和GGT联合检测诊断ALD的敏感度(96.7%)高于单项检测。结论:血清%DST和GGT对诊断ALD具有较高的临床价值,%DST诊断ALD的敏感度明显高于GGT,尤其是相对于其他肝脏酶类标志物,%DST在肝脏疾病存在时对于酒精摄入表现出更好的特异性和抗干扰能力,两者联合检测可提高单独检测的敏感度。

Objective： To explore the diagnostic value of liver traditional laboratory indexes,including alanine aminotransferase（ ALT）,aspartate aminotransferase（ AST）,γ- glutamyl transpeptidase（ GGT） and mean corpuscular volume（ MCV）,and the percentage composition of carbohydrate deficient transferrin dual sialic acid（ %DST） on alcoholic liver disease（ ALD）. Methods： Case control study was used. 30 patients with ALD and 30 patients with nonalcoholic fatty liver disease（ NAFLD） treated in our hospital from June 2014 to June 2015 as well as30 healthy persons were enrolled in this study. Their levels of serum ALT,AST,GGT,MCV and % DST were detected,and the receiver operating characteristic area under the curve（ ROC- AUC）,sensitivity and specificity in the diagnosis of ALD were respectively detected and analyzed. Results： The AUC of serum % DST and GGT,sensitivity and specificity of ALD group were all higher than those of NAFLD group and healthy control（ % DST： AUC =0. 940,90. 0% of sensitivity,90. 3% of specificity and P 0. 001; GGT： AUC = 0. 766,76. 7% of sensitivity,77. 4% of specificity and P 0. 001; ALT： AUC = 0. 502,50. 0% of sensitivity,61. 3% of specificity and P 0. 001; AST： AUC = 0. 345,33. 3% of sensitivity,71. 0% of specificity and P = 0. 433; MCV： AUC = 0. 546,43. 3% of sensitivity,77. 4% of specificity and P = 1. 000）; % DST and GGT had significant differences in ALD group; the sensitivity of % DST was higher than that of GGT in the diagnosis of ALD; and the sensitivity of the joint detection of both % DST and GGT（ 96. 7%） was higher than that of single detection in the diagnosis of ALD. Conclusions： Serum % DST and GGT have a high clinical value in the diagnosis of ALD; the sensitivity of % DST is obviously higher than that of GGT in the diagnosis of ALD,especially compared with other liver enzyme markers; %DST shows better specificity and anti- jamming capability for alcohol intake in patients with liver disease; and the joint detection of both % DST and GGT can increase the sensitivity of single detection.