血脂、血糖、肝功能和血尿酸联合检测对老年脂肪肝患者的诊断价值

Diagnostic value of combined determinations of serum lipids, blood glucose, liver function and blood uric acid in senile patients with fatty liver

目的探讨血脂、血糖、肝功能和血尿酸联合检测在老年脂肪肝患者中的诊断价值。方法选择2017年5月—2018年5月临邑县第二人民医院收治的50例老年脂肪肝患者作为老年脂肪肝组,另选择同期进行体检的50例健康体检者作为健康对照组。采用速率法检测所有研究对象的肝功能指标[包括总胆汁酸(TBA)、总胆红素(TBil)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)和γ-谷氨酰转肽酶(GGT)],采用己糖激酶法检测血脂指标[包括总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、极低密度脂蛋白胆固醇(VLDL-C)和高密度脂蛋白胆固醇(HDL-C)],采用过氧化物酶比色法检测血糖指标[包括空腹血糖(FBG)、糖化血红蛋白(HbA1C)]。分析两组血脂、血糖、肝功能和血尿酸的单独检测以及联合检测对老年脂肪肝的诊断价值。结果与健康对照组比较,老年脂肪肝组的肝功能指标TBA、TBil、AST、ALT和GGT均明显升高[TBA(μmol/L):8.23±3.41比6.13±2.02,TBil(μmol/L):15.79±4.06比11.96±2.85,AST(U/L):38.12±14.73比23.87±4.46,ALT(U/L):38.21±14.35比29.32±3.12,GGT(U/L):50.12±16.37比20.36±5.98];血脂指标TC、TG、LDL-C和VLDL-C均明显升高[TC(mmol/L):6.41±1.54比3.86±0.52,TG(mmol/L):2.80±1.76比1.21±0.32,LDL-C(mmol/L):2.78±0.82比2.01±0.43,VLDL-C(mmol/L):1.21±0.76比0.50±0.27],HDL-C明显降低(mmol/L:1.06±0.31比1.31±0.29);血糖指标FBG、HbA1C均明显升高[FBG(mmol/L):6.57±0.71比4.48±0.56,HbA1C:(6.87±0.71)%比(4.51±0.60)%];血尿酸水平明显升高(μmol/L:452.29±88.37比361.36±67.81);两组各指标比较差异均有统计学意义(均P<0.05)。血糖、血脂、肝功能、血尿酸各指标单独检测诊断脂肪肝的敏感度分别为80.0%、76.0%、78.0%、82.0%,特异度分别为90.0%、90.0%、92.0%、92.0%,准确度分别为85.0%、83.0%、85.0%、86.0%;联合检测的敏感度为98.0%,特异度为94.0%,准确度为96.0%。结论对老年脂肪肝患者联合检测血脂、血糖、肝功能和血尿酸,可有效提高诊断的敏感度和准确度。

Objective To evaluate the diagnostic value of combined detections of blood lipids, blood glucose, liver function and blood uric acid in elderly patients with fatty liver disease. Methods Fifty elderly patients with fatty liver in Linyi Second People＇s Hospital from May 2017 to May 2018 were selected as the fatty liver group, and in the same period, 50 healthy subjects were assigned as the healthy control group. Rate method was used to detect liver function indicators of all subjects in the two groups [including total bile acid（TBA）, total bilirubin（TBil）, aspartate aminotransferase（AST）, alanine aminotransferase（ALT） and γ-glutamyl transpeptidase（GGT）], hexokinase method was applied to detect blood lipid indicators [including total cholesterol（TC）, triglyceride（TG）, low density lipoprotein cholesterol（LDL-C）, very low density lipoprotein cholesterol（VLDL）-C and high-density lipoprotein cholesterol（HDL-C）], peroxidase colorimetric method was adopted to detect blood glucose indicators [including fasting blood glucose（FBG）, glycosylated hemoglobin（HbA1 C）]. The diagnostic values for senile patients with fatty liver with single item of following index detections： blood lipids, blood sugar, liver function, and blood uric acid in the two groups were analyzed, and the diagnostic value of the combined above 4 kindsof detections for such patients was also evaluated. Results Compared with the healthy control group, the liver function indexes of the elderly fatty liver group were significantly increased in TBA, TBil, AST, ALT and GGT [TBA（μmol/L）： 8.23±3.41 vs. 6.13±2.02, TBil（μmol/L）： 15.79±4.06 vs. 11.96±2.85, AST（U/L）： 38.12±14.73 vs. 23.87±4.46, ALT（U/L）： 38.21±14.35 vs. 29.32±3.12, GGT（U/L）： 50.12±16.37 vs. 20.36±5.98]; blood lipids TC, TG, LDL-C and VLDL-C were significantly increased [TC（mmol/L）： 6.41±1.54 vs. 3.86±0.52, TG（mmol/L）： 2.80±1.76 vs. 1.21±0.32, LDL-C（mmol/L）： 2.78±0.82 vs. 2.01±0.43, VLDL-C（mmol/L）： 1.21±0.76 vs. 0.50±0.27], HDL-C was significantly decreased（mmol/L： 1.06±0.31 vs. 1.31±0.29）; the blood sugar indexes FBG and HbA1 C were significantly increased [FBG（mmol/L）： 6.57±0.71 vs. 4.48±0.56, HbA1 C：（6.87±0.71）% vs.（4.51±0.60）%]; the uric acid level was significantly increased（μmol/L： 452.29±88.37 vs. 361.36±67.81）; all the above differences between the two groups were statistically significant（all P〈0.05）. The sensitivities of single following index detections： blood glucose, blood lipids, liver function, and blood uric acid in the diagnosis of fatty liver in senile patients were 80.0%, 76.0%, 78.0% and 82.0%, respectively, the specificities were 90.0%, 90.0%, 92.0% and 92.0%, respectively, the accuracy degrees were 85.0%, 83.0%, 85.0% and 86.0%, respectively; the combined detection sensitivity including above 4 kinds of index was 98.0%, its specificity was 94.0%, and accuracy degree was 96.0%. Conclusion Adopting combined detection of blood lipids, blood sugar, liver function and blood uric acid for diagnosis in elderly patients with fatty liver can effectively improve the sensitivity and accuracy of the diagnosis.