血清直接胆红素/白蛋白在酒精性肝病临床分型中的价值

Value of DB/ALB in the detection of alcoholic liver disease

目的 探讨血清直接胆红素(direct bilirubin,DB)与白蛋白(albumin,ALB)比值在酒精性肝病不同临床类型的分层诊断中的效能。方法 本研究回顾性收集了2019年9月至2021年9月于首都医科大学附属北京地坛医院就医,符合入选及排除标准的酒精性肝病(男性)患者为研究对象,按照临床类型的不同分为酒精性脂肪肝(alcoholic fatty liver disease,AFLD)组、酒精性肝硬化(alcoholic liver cirrhosis,ALC)组、重症酒精性肝炎(severe alcoholic hepatitis,SAH)组,收集患者的临床资料,肝功能、血常规等指标,评价DB/ALB在区分不同临床类型酒精性肝病的价值,并与谷草转氨酶(aspartate aminotransferase,AST)/谷丙转氨酶(alanine aminotransferase,ALT)、谷氨酰转肽酶(gammaglutamyl transferase,GGT)、平均红细胞体积(mean corpuscular volume,MCV)水平及各项指标的诊断效能进行比较。结果 共纳入187例研究对象,其中AFLD组30例、ALC组106例、SAH组51例,DB/ALB在AFLD组、ALC组及SAH组分别为0.69 (0.46,1.33)、3.40 (1.47,6.17)、19.42 (10.14,35.26),为逐渐升高趋势,且不同组间比较差异有统计学意义(P<0.000 1),AST/ALT在AFLD组、ALC组及SAH组分别为0.84 (0.64,1.28)、1.57 (1.25,2.17)、2.07 (1.60,2.64),也呈现上升趋势,且不同组间比较也有统计学意义(P<0.000 1)。而GGT及MCV仅在AFLD组和SAH组(P=0.038;P=0.005)及ALC组和SAH组间(P=0.011;P=0.005)比较差异有统计学意义;在AFLD组和ALC组间比较差异无统计学意义(P=1.00)。在区分酒精性脂肪肝和酒精性肝硬化及区分酒精性肝硬化与重症酒精性肝炎时,DB/ALB曲线下面积分别是0.879 5与0.913 7,均优于AST/ALT的曲线下面积(分别为0.763 7与0.676 8)。结论 DB/ALB可用于区分酒精性脂肪肝、酒精性肝硬化及重症酒精性肝炎,区分效能优于AST/ALT,而GGT及MCV均不能有效区分酒精性肝病的不同临床分型。

Objective The aim of this study was to investigate the efficacy of serum direct bilirubin(DB)to albumin(ALB)ratio in the stratified diagnosis of different clinical types of alcoholic liver disease.Methods This study retrospectively collected alcoholic liver disease(male)patients who met the inclusion and exclusion criteria in Beijing Ditan Hospital,Capital Medical University from September 2019 to September 2021 as the research objects.According to different clinical types,they were divided into alcoholic fatty liver disease(AFLD),alcoholic liver cirrhosis(ALC),and severe alcoholic hepatitis(SAH).The clinical data,liver function,blood routine and other indicators of the patients were collected.We evaluated the value of DB/ALB in different clinical types of alcoholic liver disease and compared the diagnostic efficacy of DB/ALB with AST/ALT,gamma-glutamyl transferase(GGT),mean corpuscular volume(MCV)and other indicators.Results A total of 187 subjects were included,including 30 AFLD,106 ALC and 51 SAH.DB/ALB in AFLD,ALC and SAH groups were 0.69(0.46,1.33),3.40(1.47,6.17)and 19.42(10.14,35.26),respectively.The AST/ALT values in AFLD group,ALC group and SAH group were 0.84(0.64,1.28),1.57(1.25,2.17)and 2.07(1.60,2.64),respectively.There were significant differences among different groups(P<0.000 1).GGT and MCV differed statistically only between the AFLD and SAH groups(P=0.038;P=0.005)and between the ALC and groups(P=0.011;P=0.005);the difference was not statistically significant when comparing between the AFLD and ALC groups(P=1.00).The areas under the curve of DB/ALB were 0.879 5 and 0.913 7,respectively,which were better than those of AST/ALT(0.763 7 and 0.676 8,respectively)when distinguishing alcoholic fatty liver disease from alcoholic cirrhosis and alcoholic cirrhosis from severe alcoholic hepatitis.Conclusions DB/ALB can be used to distinguish alcoholic fatty liver disease,alcoholic cirrhosis and severe alcoholic hepatitis,and the discrimination efficiency is better than that of AST/ALT,while GGT and MCV cannot effectively distinguish different clinical types of alcoholic liver disease.