常用生化酶谱和肝纤维化指标在肝硬化静止期与慢性肝功能衰竭鉴别诊断中的意义

Clinical value of biochemical indicator and hepatic fibrosis in differential diagnosis of patients with cirrhosis and chronic liver failure

目的探讨常用生化酶谱及肝纤维化四项指标在肝硬化静止期和慢性肝功能衰竭鉴别诊断中的临床意义.方法选择舟山医院2015年12月至2018年12月收治的肝硬化静止期和慢性肝功能衰竭患者各30例,检测患者血清丙氨酸氨基转移酶(ALT)、天门冬氨基酸转移酶(AST)、总胆红素(TBil)、透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PC-Ⅲ)和Ⅳ型胶原(Ⅳ-C),通过受试者工作曲线(ROC)分析其在两种疾病鉴别诊断中的意义.结果肝硬化静止期的血清ALT、AST、TBil水平均低于慢性肝功能衰竭患者,差异均有统计学意义[(258.17±88.19)U/L比(818.37±375.83)U/L、(256.57±97.21)U/L比(738.63±329.68)U/L、(51.37±22.13)μmol/L比(157.27±85.60)μmol/L,t=-7.95、-7.68、-6.56,均P<0.01].肝硬化静止期的血清HA、LN、PC-Ⅲ、Ⅳ-C水平均高于慢性肝功能衰竭患者,差异均有统计学意义[(433.10±214.39)μg/L比(81.56±27.80)μg/L、(157.67±52.60)μg/L比(66.06±24.06)μg/L、(126.63±35.24)μg/L比(70.96±19.71)μg/L、(162.26±53.93)μg/L比(76.13±27.90)μg/L,t=8.90、8.67、7.49、7.76,均P<0.01].结局变量选择肝功能衰竭患者时,ALT、AST、TBil中以ALT的曲线下面积(AUC)0.973最大.结局变量选择肝硬化静止期患者,HA、LN、PC-Ⅲ、Ⅳ-C中以HA的AUC 0.993最大.结论ALT和HA可作为肝硬化静止期和慢性肝功能衰竭相互鉴别诊断的依据.

Objective To investigate the clinical value of biochemical indicator and hepatic fibrosis in differential diagnosis of patients with cirrhosis and chronic liver failure.Methods From December 2015 to December 2018,30 patients with cirrhosis and 30 patients with chronic liver failure in Zhoushan Hospital were selected.The serum levels of ALT,AST,TBil,hyaluronic acid(HA),laminin(LN),PC-Ⅲ,collagen typeⅣ(Ⅳ-C)were detected.Results The serum levels of ALT,AST and TBil in patients with cirrhosis were significantly lower than those in patients with chronic liver failure[(258.17±88.19)U/L vs.(818.37±375.83)U/L;(256.57±97.21)U/L vs.(738.63±329.68)U/L;(51.37±22.13)μmol/L vs.(157.27±85.60)μmol/L,t=-7.95,-7.68,-6.56,all P<0.01].The serum levels of HA,LN,PC-ⅢandⅣ-C in patients with cirrhosis were significantly higher than those in patients with chronic liver failure[(433.10±214.39)μg/L vs.(81.56±27.80)μg/L;(157.67±52.60)μg/L vs.(66.06±24.06)μg/L;(126.63±35.24)μg/L vs.(70.96±19.71)μg/L;(162.26±53.93)μg/L vs.(76.13±27.90)μg/L,t=8.90,8.67,7.49,7.76,all P<0.01].When patients with chronic liver failure were set as state variable,AUC of ALT(0.973)was the highest in ALT,AST,TBil.When patients with cirrhosis were set as state variable,AUC of HA(0.993)was the highest in HA,LN,PC-ⅢandⅣ-C.Conclusion ALT and HA are suitable for differential diagnosis of patients with cirrhosis and chronic liver failure.