亮氨酸氨基肽酶在胆道梗阻性疾病中的应用

Application of leucine aminopeptidase in biliary obstructive diseases

目的 探讨亮氨酸氨基肽酶(LAP)在胆道梗阻性疾病中的作用,评估LAP及其联合碱性磷酸酶(AKP)、γ-谷氨酰转肽酶(GGT)以及5′-核苷酸酶(5′-NT)对胆道梗阻性疾病的诊治价值.方法 收集中南大学湘雅医院2016年10月至2017年3月健康体检者、无症状HBV携带者、肝炎患者、胆道梗阻患者、肝硬化患者及原发性肝癌患者样本共181例,分别采用相应试剂盒检测LAP、AKP、GGT及5′-NT,并进行统计学分析.结果 LAP水平在胆道梗阻患者中最高,与其他各组差异均具有统计学意义(P<0.05);在胆道梗阻性疾病组中,LAP与AKP、GGT及5′-NT均呈正相关(r=0.690,P<0.01;r=0.864,P<0.01;r=0.735,P<0.01);LAP、5′-NT、GGT及AKP单独诊断胆道梗阻性疾病的ROC曲线下面积(AUC)分别为0.945,0.942,0.916和0.898,LAP联合5′-NT,GGT及AKP的AUC为0.966,LAP联合5′-NT的AUC为0.968.结论 LAP可以作为胆道梗阻性疾病的一项初步鉴别诊断指标,联合5′-NT后其诊断价值进一步提高,具有较好的临床诊断价值.

Objective To investigate the role of leucine aminopeptidase in biliary obstructive dis-ease, and to evaluate the value of leucine aminopeptidase and its combination with alkaline phosphatase (AKP), glutamine transferase and 5′-nucleotidase (5′-NT) in diagnosis and treatment of bile duct obstruc-tion. Methods A total of 181 cases were collected, who were diagnosed as healthy, asymptomatic HBV carriers and patients with hepatitis, biliary obstruction, liver cirrhosis and primary liver cancer samples at Xiangya Hospital of Central South University from October 2016 to March 2017. The leucine aminopeptidase (LAP), AKP, gamma glutamyl transpeptidase (GGT) and 5′-NT were detected with the corresponding kits, and analyzed with different statistical methods. Results The highest level of LAP was in patients with biliary obstruction, compared to other groups, and the differences were statistically significant (P<0. 05). In biliary obstruction group, LAP and AKP, GGT and 5′-NT were correlated ( r=0. 690, P<0. 01; r=0. 864, P<0. 01;r=0. 735, P<0. 01). Receiver operating characteristic (ROC), curve area (AUC) of LAP, 5′-NT, GGT and AKP in the diagnosis of biliary obstruction were 0. 945 and 0. 898, 0. 942 and 0. 916;the AUC of LAP combined with 5′-NT, GGT and AKP was 0. 966;and the AUC of LAP combined with 5′-NT was 0. 968. Conclusions LAP can be used as a preliminary index of differential diagnosis of biliary obstructive disease, and its diagnostic value could be improved when combined with 5-NT.