特异抗体联合血液指标在无症状胆囊结石患者华支睾吸虫感染诊断的应用

Combination of antibody with other blood indexes can improve the diagnostic efficiency for Clonorchis sinensis infection in asymptomatic gallstone patient

目的探讨多项血液指标联合检测在胆囊结石患者合并华支睾吸虫感染诊断中的作用和意义。方法连续检测192例无症状胆囊结石病人的胆囊结石、胆汁和血液。以胆囊胆汁和/或结石中发现虫卵为华支睾吸虫病确诊依据,同时分析评价有关血液指标的独立和联合诊断价值,指标包括:嗜酸性粒细胞百分比(EO%)、单核细胞百分比(MO%)、华支睾吸虫IgG抗体(C.sinensis IgG)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、γ-谷氨酰基转移酶(GGT)、碱性磷酸酶(ALP)、总胆汁酸(TBA)、胆碱酯酶(CHE)和α-L-岩藻糖苷酶(AFU)。结果所有患者中确诊华支睾吸虫病117例,阳性率为60.9%(117/192)。Logistic回归分析显示有诊断意义(阳性或升高)的单项指标为EO%、C.sinensis IgG、ALT和GGT,其ROC曲线下面积(AUC)分别是0.638、0.817、0.514和0.602,以C.sinensis IgG诊断价值最高;4个指标不同组合模式的诊断价值比较:所有组合模式中,以不包含C.sinensis IgG的EO%+ALT+GGT组合诊断价值最差(AUC=0.695);四者联合的诊断价值最高(AUC=0.876);三联组合中价值最高为C.sinensis IgG+EO%+GGT(AUC=0.869);二联组合最高为GGT+C.sinensis IgG(AUC=0.854)。结论血清华支睾吸虫抗体联合EO%、ALT和GGT检测可提高无症状胆囊结石患者华支睾吸虫感染的诊断效率。

Objective To investigate the role and significance of the combination of some blood indexes for Clonorchis sinensis(C.sinensis) infection in asymptomatic gallstone patient.Methods In this study,total of 192 asymptomatic gallstone patients were enrolled and their gallbladder bile,stones and blood were analyzed consecutively.Clonorchiasis confirmation was based on the C.sinensis egg was found in gallbladder bile and/or stones.The independent and combined diagnostic value of the related blood indexes were analyzed and evaluated simultaneously.Those indexes included:the percentage of eosinophils(EO%),the percentage of monocytes(MO%),C.sinensis IgG,alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),γ-glutamyl transferase(GGT),alkaline phosphatase(ALP),total bile acid(TBA),cholinesterase(CHE) and α-L-fucosidase(AFU).Results 117 cases of clonorchiasis were confirmed in all patients,with positive rate of 60.9%(117/192).Logistic regression analysis showed that EO%,C.sinensis IgG,ALT and GGT could serve as single index with a diagnostic significance(positive or elevated),and the areas under the ROCcurve(AUC) of these indexes were 0.638,0.817,0.514 and 0.602,respectively.C.sinensis IgG had the highest diagnostic value of the four indexes.The diagnositic value of EO%+ALT+GGT combination was the lowest(AUC=0.695);the mode with highest value was the combination of all four indexes(EO%+ALT+GGT+C.sinensis IgG,AUC=0.876);the mode of triple combination with highest value was C.sinensis IgG+EO%+GGT(AUC=0.869) and the highest bivalent combination mode was C.sinensis IgG+GGT(AUC=0.854).Conclusion C.sinensis antibody combined with the detection of EO%,ALT and GGT could improve the diagnostic efficacy for C.sinensis infection in asymptomatic gallstone patient.