Graves病合并肝细胞损害血清甘胆酸检测的临床意义

Clinical Significance of Serum Cholyglycine Detection in Graves' Disease Complicated by Hepatocellular Damage

目的探讨毒性弥漫性甲状腺肿(Graves病)合并肝细胞损害患者血清甘胆酸(CG)检测的临床意义。方法选择Graves病患者136例,将136例患者根据是否合并肝细胞损害分为2组:Graves病合并肝细胞损害(A)组(69例)和单纯Graves病(B)组(67例)。检测2组血清CG、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(GGT)的活性及总胆红素(TBIL)的水平,并与正常对照组进行比较。对Graves病合并肝细胞损害患者血清CG水平与血清ALT、AST、GGT、ALP活性,TBIL水平进行相关性分析。分析CG单独及联合AST、ALT指标在诊断Graves病合并肝细胞损害的ROCAUC、敏感性和特异性。结果 B组血清ALT、AST、GGT、ALP活性及CG、TBIL水平与正常对照组比较差异无统计学意义(P>0.05),A组血清ALT、AST、GGT、ALP活性及CG、TBIL水平均明显高于B组、正常对照组(均P<0.05)。Graves病合并肝细胞损害患者血清CG水平与血清ALT、AST、GGT、ALP活性,TBIL水平均呈正相关(r=0.191、0.357、0.246、0.148、0.473,均P<0.05);Graves病合并肝细胞损害患者CG和AST的曲线下面积分别为0.697、0.771,CG+AST的ROCAUC最大,为0.811,且敏感性(68.97%)、特异性(94.03%)均明显高于单独血清CG或AST。结论血清CG是评价Graves病合并肝细胞损害的敏感指标,联合AST检测可以为临床医生对Graves病患者合并肝细胞损害的诊断提供参考。

Objective To investigate the clinical significance of serum cholyglycine（CG） detec-tion in Graves, disease complicated by hepatocellular damage. Methods Serum levels of CG ,a la -nine aminotransferase （ALT） , aspartate aminotransferase （AST）,alkaline phosphatase （ALP ）, gamma-glutamyltransferase（GGT） and total bilirubin （TBIL） were detected in 136 Graves, dis-ease patients with hepatocellular damage（group A ,n -69） or no t（group B ,n = 67）. Fur thermore, the relationships of serum CG levels to serum ALT,AST,GGT and ALP activities and TBIL lev-els were analyzed in group A. Moreover,the area under the receiver operating characteristic curve （ROCAUC） , sensitivity and specificity of CG alone or in combination with AST and ALT in the di-agnosis of Graves, disease complicated by hepatocellular damage were measured. Results There were no significant differences in serum ALT, AST, GGT and ALP activities and CG and TBIL levels between control group and group B（P〉0. 05）. However,serum ALT,AST,GGT and ALP activities and CG and TBIL levels in group A were significantly higher than those in group B and control group（P〈0 . 05）. In patients with Graves, disease complicated by hepatocellular damage, serum CG levels were positively with serum ALT,AST,GGT and ALP activities and TBIL levels （r=0. 191,0. 357,0. 246,0. 148 and 0. 473, respectively; P〈0. 05）. The ROCAUC was 0. 697 for CG,0. 771 for AST,and 0. 811 for their combination. Moreover,the combined detection of CG and AST had higher sensitivity（68. 97%） and specificity（94. 03%） than the detection of CG or AST alone. Conclusion Serum CG is a sensitive index of Graves, disease complicated by hepatocellular damage. The combined detection of CG and AST can provide the reference for the diagnosis of Graves, disease complicated by hepatocellular damage.