γ-谷氨酰转移酶对胆总管结石的预判价值

Diagnostic value of γ-glutamyltransferase for common bile duct stones

目的探讨γ-谷氨酰转肽酶(γ-glutamyltransferase,GGT)异常对胆总管结石的诊断价值。方法回顾分析2016年1月至2016年12月行腹腔镜联合胆道镜行胆总管探查术的248例患者的临床资料,以胆道镜发现胆总管结石为金标准,评价患者术前GGT对胆总管结石诊断的灵敏度和特异度,构建受试者工作特征(receiver operating characteristic,ROC)曲线。结果术前检测GGT对胆总管结石的诊断情况如下:ROC曲线下面积为0.729,最佳诊断点的临界值为93.5 U/L,对应的灵敏度和特异度分别为78.47%和56.73%,阳性预测值和阴性预测值为21.34%~24.25%和93.72~95.95%,准确率为69.35%;去除泥沙样结石后:ROC曲线下面积为0.779,计算所对应最佳诊断点的临界值为93.5 U/L,对应的灵敏度和特异度分别为74.36%和74.04%,阳性预测值和阴性预测值为24.14%~33.58%和94.24%~96.29%,准确率为74.2%。结论 GGT为胆总管结石诊断的灵敏度指标,但对于泥沙样结石的特异度不高。当GGT>93.5 U/L时,应高度怀疑胆总管结石,应进一步行磁共振胰胆管造影(magnetic resonance cholangiopancreatography,MRCP)或内镜逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)检查,并可作为胆总管探查的指征之一。

Objective To investigate the diagnostic value of γ-glutamyltransferase（GGT） for common bile duct stones.Methods The retrospective study was conducted.The clinical data of 248 patients who were treated by laparoscopic transcysitc common bile duct exploration（LTCBDE） from January 2016 to December 2016 were collected.To evaluate the sensitivity and specificity of preoperative GGT in the diagnosis of common bile duct stones,the golden standard was the common bile duct stones were found by choledochoscopy.The receiver operating characteristic（ROC） curve was done for indicators.Results The result of preoperative detection of GGT in the diagnosis of common bile duct stones was as follows：the area under the ROC curve was 0.729,the correspondent cut-off value of diagnostic accuracy,sensitivity,specificity,positive predictive rate,negative predictive rate and the accuracy were 93.5 U/L,78.47%,56.73%,21.34%-24.25%,93.72-95.95% and 69.35%,respectively;After removal of silt stones：the area under the ROC curve was 0.779,the correspondent cut-off value of diagnostic accuracy,sensitivity,specificity,positive predictive rate,negative predictive rate and the accuracy were 93.5 U/L,74.36%,74.04%,24.14%-33.58%,94.24%-96.29% and 74.2% respectively.Conclusion GGT is a sensitive indicators for the diagnosis of common bile duct stones,but it is low specific.It should be highly suspected common bile duct stones when GGT93.5 U/L,magnetic resonance cholangiopancreatography（MRCP） or endoscopic retrograde cholangiopancreatography（ERCP）should be further examined.And it can be used as one of the indications of common bile duct exploration.