肝功能联合血常规检测对燃煤污染型地方性砷中毒患者肝损伤的诊断价值

The diagnositic value of combination detection of liver function and blood routine in the identification of liver damage of patients with coal-burning arsenicosis

目的探讨肝功能联合血常规指标检测对燃煤污染型地方性砷中毒(燃煤型砷中毒)患者肝损伤的诊断价值。方法226例燃煤型砷中毒病区砷中毒患者参考GBZ 59-2010《职业性中毒性肝病诊断标准》分为无肝损伤组(n=114)和肝损伤组(n=112),另选无燃用高砷煤史且其他条件与病区相近的邻村健康居民为对照组(n=95),收集所有观察对象的一般资料(包括年龄、性别、吸烟情况及饮酒情况);取所有观察对象清晨空腹静脉血,采用全自动生化分析仪检测血清肝功能指标[总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)及谷氨酰转肽酶(GGT)],采用血细胞分析仪检测血常规指标(包括白细胞计数、淋巴细胞计数、中间细胞计数、中性粒细胞计数、淋巴细胞数百分比、中间细胞数百分比、中性粒细胞数百分比、血红蛋白浓度、红细胞计数、红细胞压积、平均红细胞体积、平均红细胞血红蛋白含量、平均红细胞血红蛋白浓度、血小板计数、平均血小板体积、血小板分布宽度及血小板压积);采用受试者工作特征(ROC)曲线下面积(AUC)分析肝功能与血常规指标联合应用对砷中毒肝损伤的诊断价值。结果肝损伤组砷中毒患者TBIL、ALT、AST、GGT含量较对照组和无肝损伤组均升高(P<0.05);无肝损伤组和肝损伤组砷中毒患者平均血小板体积和血小板分布宽度较对照组升高,血小板计数、血小板压积较对照组降低,砷中毒肝损伤组中性粒细胞计数、中性粒细胞数百分比、血红蛋白浓度、红细胞压积和平均红细胞体积较对照组均升高,淋巴细胞数百分比较对照组降低(P<0.05);肝损伤组砷中毒患者中性粒细胞数百分比、血红蛋白浓度、红细胞计数、红细胞压积、平均红细胞体积和平均血小板体积较无肝损伤砷中毒患者均升高(P<0.05);肝功能与血常规联合检测诊断砷中毒患者肝损伤的AUC、灵敏度和特异度分别为0.940、85.7%、90.40%,识别价值优于肝功能或血常规单独检测。结论肝功能和血常规指标联合检测可提高对燃煤型砷中毒患者肝损伤的诊断价值。

Objective To explore the value of combination detection of liver function and blood routine in the identification of liver damage of patients with coal-burning type of endemic arsenicosis.Methods A total of 226 patients with arsenicosis from coal-burning arsenicosis areas were divided into the arsenicosis group without liver damage(n=114)and the arsenicosis group with liver damage(n=112)according to the Diagnostic Criteria of Occupational Toxic Liver Disease(GBZ 59-2010).In addition,healthy residents in neighboring villages with no history of using As-rich coal and other conditions similar to the disease areas were selected as the control group(n=95).General information(including age,sex,smoking and alcohol consumption)was collected for all the subjects.Fasting venous blood of the subjects was collected in the morning,and serum liver function indicators[total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),and glutamyltranspeptase(GGT)]were detected by automatic biochemical analyzer.Blood routine indicators(including white blood cell count,lymphocyte count,intermediate cell count,neutrophil count,percentage of lymphocytes,percentage of intermediate cells,percentage of neutrophils,hemoglobin concentration,red blood cell count,hematokrit,mean corpuscular volume,mean erythrocyte hemoglobin content,mean corpuscular-hemoglobin concentration,blood platelet count,mean platelet volume,platelet distribution width,thrombocytocrit)were detected by the blood cell analyzer.The receiver operating characteristic(ROC)curve was used to analyze the identify value of the combination of liver function and blood routine of liver damage caused by arsenicosis.Results The contents of TBIL,ALT,AST,and GGT of the arsenicosis with liver damage group increased more than those of the control group and the group without liver damage(all P<0.05).The mean platelet volume and platelet distribution width of the group without liver damage and liver damage group were higher than that in the control group,and the platelet count and platelet accumulation were lower than that in the control group.Neutrophil count,percentage of neutrophil number,hemoglobin concentration,hematocrit and mean volume of red blood cells all increased in the liver damage group compared with the control group(P<0.05).The percentage of neutrophil number,hemoglobin concentration,red blood cell count,hematocrit,mean red blood cell volume and mean platelet volume of arsenicosis patients with liver damage were higher than those without liver damage(P<0.05).The ROC curve of the combination of liver function and blood routine showed a robust ability in the identification of liver damage of patients with arsenicosis,with an area under the ROC curve of 0.940 and the sensitivity and specificity of 85.7%and 90.40%,respectively.The combined liver function and blood routine test had better identification value than the liver function and blood routine alone.Conclusion The combination detection of liver function and blood routine could improve the identification value of liver damage of patients with coal-burning type of endemic arsenicosis.