血清腺苷脱氨酶水平在自身免疫性肝炎诊断中的应用价值

Application value of serum adenosine deaminase level in the diagnosis of autoimmune hepatitis

目的探讨血清腺苷脱氨酶(ADA)水平在自身免疫性肝炎(AIH)诊断中的应用价值。方法比较AIH患者(AIH组,55例)和健康体检者(对照组,55例)血清ADA水平。根据诊断AIH的血清ADA水平最佳诊断界值,AIH组分为高水平ADA组(ADA≥19 U/L,12例)和正常ADA组(ADA<19 U/L,43例),比较两组临床特征、生化指标及病理特征,分析AIH组ADA水平与相关指标间的相关性。绘制ROC曲线分析血清ADA水平与其他指标诊断中-重度界面性肝炎的效能。结果AIH组血清ADA水平高于对照组(P<0.01)。血清ADA诊断AIH的最佳诊断界值为19 U/L,其诊断AIH的灵敏度和特异度分别为78.2%和90.9%。与正常ADA组比较,高水平ADA组年龄较大,黄疸发生率较高,白蛋白(Alb)水平较低,AST、TBil和IgG水平较高,中-重度界面性肝炎比例较高(P<0.05或P<0.01)。AIH组血清ADA水平与ALT、AST、IgG、TBil及界面性肝炎严重程度呈正相关(P<0.05或P<0.01),与Alb呈负相关(P<0.01)。血清ADA诊断中-重度界面性肝炎的AUC和灵敏度均大于ALT、AST和IgG(P<0.05)。结论血清ADA水平对AIH具有较高的诊断价值,且诊断中-重度界面性肝炎灵敏度高。

Objective To explore the application value of serum adenosine deaminase(ADA)level in the diagnosis of autoimmune hepatitis(AIH).Methods Serum ADA levels were compared between AIH patients(group AIH,55 cases)and physical examination people(group C,55 cases).According to the cut-off value of serum ADA level for diagnosing AIH,group AIH was divided into two groups of A1(ADA≥19 U/L,12 cases)and A2(ADA<19 U/L,43 cases).The clinical characteristics,biochemical indicators and pathological characteristics of two groups were compared.The correlation between ADA level and the relevant indicators of group AIH was analyzed.ROC curve was drawn to analyze the efficacy of serum ADA level and other indicators in the diagnosis of moderate-severe interfacial hepatitis.Results Serum level of ADA in group AIH was higher than that in group C(P<0.01).Taking 19 U/L as the cut-off value of serum ADA level,the sensitivity and specificity for ADA diagnosing AIH were 78.2%and 90.9%,respectively.Compared to group A2,group A1 had order age,higher proportion of the patients with jaundice,higher levels of AST,TBil and IgG,lower level of albumin(Alb),and higher percentage of the patients with moderate-severe interfacial hepatitis(P<0.05 or P<0.01).Serum ADA level in group AIH was positively correlated with ALT,AST,IgG,TBil and the severity of interfacial hepatitis(P<0.05 or P<0.01),and negatively correlated with Alb(P<0.01).The AUC and the sensitivity of serum ADA in the diagnosis of moderate-severe interfacial hepatitis were more than those of ALT,AST and IgG(P<0.05).Conclusion Serum ADA level has higher diagnostic value for AIH with a higher sensitivity in the diagnosis of moderate-severe interfacial hepatitis.