检测谷胱甘肽还原酶活性水平在乙型肝炎辅助诊断中的应用

Application of detecting activity levels of glutathione reductase in auxiliary diagnosis of hepatitis B

目的探讨检测血清谷胱甘肽还原酶(GR)活性水平在乙型肝炎辅助诊断中的应用价值。方法选取140例确诊为乙型肝炎的患者作为阳性组,另选取同期430例表观健康者作为对照组,检测两组研究对象的血清丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、GR以及总胆红素(TBIL)水平。采用组间比较和分层比较评估GR活性水平与由乙型肝炎引起肝损伤的关联性和诊断效能。结果两组研究对象的年龄、ALT、AST、TBIL、ALP和GR检测结果均呈非正态分布。对照组研究对象年龄中位数为35.0岁,略高于阳性组的33.0岁,但两组比较差异无统计学意义(P>0.05);阳性组ALT、AST、TBIL、ALP、GR水平均显著高于对照组,差异具有统计学意义(P<0.05)。对ALT、AST、TBIL、ALP和GR进行受试者工作特征(ROC)曲线分析,可知血清GR活性水平对乙肝患者肝损伤的诊断界值为61.5 U/L,曲线下面积(AUC)为0.882[95%CI=(0.845, 0.919), P<0.05],灵敏度为78.6%,特异度为89.3%。对不同生物标志物的ROC曲线进行比较, ALT和AST的AUC最大,但两者比较差异无统计学意义(P>0.05);GR的AUC次于ALT和AST,但优于TBIL和ALP,比较差异均具有统计学意义(P<0.05);TBIL和ALP的AUC较差,两者比较差异无统计学意义(P>0.05)。将阳性组研究对象按GR活性水平四分位数间距(Q)进行分层:ALT和AST活性水平均随GR活性水平的升高而升高(P<0.05),在Q1~Q2区间内升高较缓(P>0.05),在Q3~Q4区间内迅速升高(P<0.05);TBIL和ALP在Q1~Q3区间内趋势不显著(P>0.05),仅有Q4与其他层级相比有显著升高(P<0.05);年龄未显示出明显的趋势(P>0.05)。结论血清GR活性水平升高与由乙型肝炎引起的肝损伤显著相关,检测血清GR活性水平可作为辅助诊断、治疗各类肝病、评估肝损伤程度的方法。

Objective To discuss the application value of serum glutathione reductase(GR) activity level in the auxiliary diagnosis of hepatitis B. Methods There were 140 patients with hepatitis B selected as the positive group and concurrent 430 patients with apparent health as the control group. The levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), alkaline phosphatase(ALP), GR and total bilirubin(TBIL) of the two groups were detected. Inter-group comparison and stratified comparison were used to evaluate the correlation and diagnostic efficacy of GR activity level with liver injury caused by hepatitis B. Results The age, ALT, AST, TBIL, ALP and GR test results of the two groups showed non-normal distribution. The median age of the control group was 35.0 years old, which was slightly higher than 33.0 years of the positive group, but there was no significant difference between the two groups(P>0.05). The levels of ALT, AST, TBIL, ALP and GR in the positive group was significantly higher than those in the control group, and the difference was statistically significant(P<0.05). The receiver operator characteristic(ROC) curve analysis of ALT, AST, TBIL, ALP and GR showed that the diagnostic threshold of serum GR activity for liver injury in patients with hepatitis B was 61.5 U/L, area under the curve(AUC) was 0.882 [95%CI=(0.845, 0.919), P<0.05], sensitivity was 78.6%, and specificity was 89.3%. Comparing the ROC curves of different biomarkers, AUC of ALT and AST had the highest diagnostic efficacy, but there was no statistically significant difference between the two(P>0.05). AUC of GR was inferior to ALT and AST, but it was better than TBIL and ALP, and the difference was statistically significant(P<0.05). AUC of TBIL and ALP were worse, and the difference was not statistically significant(P>0.05). The positive group were stratified according to the quartile interval(Q) of GR activity level: ALT and AST activity levels increased with the increase of GR activity level(P<0.05), increased slowly in the interval of Q1-Q2(P>0.05), and increased rapidly in the interval of Q3-Q4(P<0.05). TBIL and ALP did not show significant trends in the Q1-Q3 interval(P>0.05). Only at Q4 it showed a significant increase compared to other levels(P<0.05), and age did not show a significant trend(P>0.05). Conclusion The increase of serum GR activity was significantly related to liver injury caused by hepatitis B. The detection of GR activity in serum can be used as an assistant method to diagnose, treat various liver diseases and evaluate the degree of liver injury.