谷胱甘肽还原酶联合检测在乙型肝炎中的应用

Application value of glutathione reductase combined detection in hepatitis B

目的探讨血清谷胱甘肽还原酶(GR)水平与乙型肝炎(乙肝)的相关性及临床应用价值。方法选择东莞康华医院2019年8月—2020年8月收治的306例乙肝患者作为阳性组,另外选择同期450名健康体检者作为对照组。分别检测所有受检者的血清GR、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)以及γ-谷氨酰转移酶(GGT)水平;采用组间比较和分层比较评估GR水平与乙肝的相关性,采用组内和组间单因素分析评估GR水平与ALT、AST、ALP、GGT的相关性;绘制受试者工作特征曲线(ROC曲线)并计算曲线下面积(AUC),分析不同生化指标对乙肝肝损伤的诊断效能。结果血清GR、ALT、AST、ALP和GGT水平在阳性组均明显高于对照组〔GR(U/L):63.6(55.7,75.4)比49.7(44.4,54.2),ALT(U/L):71.0(49.0,154.0)比20.0(14.0,26.0),AST(U/L):46.0(33.8,82.0)比20.0(17.0,24.0),ALP(U/L):81.0(67.0,105.3)比60.0(51.0,72.0),GGT(U/L):41.0(21.0,99.0)比20.0(13.0,31.0),均P<0.05〕。Pearson相关性分析结果显示,乙肝患者GR与ALT、AST、ALP、GGT均呈正相关(r值分别为0.734、0.694、0.458、0.527,P值分别为<0.001、<0.001、<0.001、<0.001)。血清GR的AUC为0.852〔95%可信区间(95%CI)为0.824~0.881,P<0.01〕,次于ALT(AUC为0.946,95%CI为0.928~0.965,P<0.01)和AST(AUC为0.948,95%CI为0.931~0.965,P<0.01),但优于ALP(AUC为0.780,95%CI为0.747~0.814,P<0.01)和GGT(AUC为0.768,95%CI为0.733~0.804,P<0.01)。将阳性组按GR的四分位数间距(QR)进行分层,结果显示随GR升高ALT和AST均升高,在Q1~Q3区间升高较为缓慢,在Q3~Q4区间升高较为迅速;ALP和GGT在Q1~Q3区间变化趋势不显著,Q4与其他层级相比有显著升高。结论GR是乙肝肝损伤的影响因素之一,可作为肝损伤程度的评估指标,为现有肝功能检测提供补充。

Objective To investigate the correlation between serum glutathione reductase (GR) level and hepatitis B and its clinical value.Methods 306 patients with hepatitis B admitted to Kanghua Hospital of Donguan City from August 2019 to August 2020 were selected as positive group,other 450 healthy subjects in the same period were selected as control group.The levels of serum GR,alanine aminotransferase (ALT),aspartate aminotransferase (AST),alkaline phosphatase (ALP) and γ-glutamyltransferase (GGT) were detected.The correlation between GR and hepatitis B was evaluated by inter group and stratified comparison.The correlation among GR and ALT,AST,ALP,GGT was evaluated by intra group and inter group univariate analysis.The receiver operating characteristic curve (ROC curve) was drawn and the area under curve (AUC) was calculated to analyze the diagnostic efficacy of different biomarkers for hepatitis B liver injury.Results The levels of GR,ALT,AST,ALP and GGT in positive group were higher than those in control group[GR (U/L):63.6 (55.7,75.4) vs.49.7 (44.4,54.2),ALT (U/L):71.0 (49.0,154.0) vs.20.0 (14.0,26.0),AST (U/L):46.0 (33.8,82.0) vs.20.0 (17.0,24.0),ALP (U/L):81.0 (67.0,105.3)vs.60.0 (51.0,72.0),GGT (U/L):41.0 (21.0,99.0) vs.20.0 (13.0,31.0),all P < 0.05].Pearson correlation analysis showed that GR was positively correlated with ALT,AST,ALP,GGT (r values were 0.734,0.694,0.458,0.527,P values were < 0.001,< 0.001,< 0.001,< 0.001).The AUC of serum GR was 0.852[95% confidence interval (95%CI) was 0.824-0.881,P < 0.01],which was lower than ALT (AUC was 0.946,95%CI was 0.928-0.965,P < 0.01)and AST (AUC was 0.948,95%CI was 0.931-0.965,P < 0.01),but better than ALP (AUC was 0.780,95%CI was 0.747-0.814,P < 0.01) and GGT (AUC was 0.768,95%CI was 0.733-0.804,P < 0.01).The subjects in positive group were stratified according to the quartile spacing (QR) of GR.The levels of ALT and AST increased with the increase of GR,slowly in Q1-Q3 and rapidly in Q3-Q4;ALP and GGT did not change significantly inQ1-Q3,but increased significantly in Q4 compared with other levels.Conclusion GR is one of the influencing factors of hepatitis B liver injury,which can be used as an index to evaluate the degree of liver injury and provide a supplement for the existing liver function test.