Gamma-glutamyl transferase 5 overexpression in cerebrovascular endothelial cells improves brain pathology,cognition,and behavior in APP/PS1 mice

In patients with Alzheimer’s disease,gamma-glutamyl transferase 5(GGT5)expression has been observed to be downregulated in cerebrovascular endothelial cells.However,the functional role of GGT5 in the development of Alzheimer’s disease remains unclear.This study aimed to explore the effect of GGT5 on cognitive function and brain pathology in an APP/PS1 mouse model of Alzheimer’s disease,as well as the underlying mechanism.We observed a significant reduction in GGT5 expression in two in vitro models of Alzheimer’s disease(Aβ_(1-42)-treated hCMEC/D3 and bEnd.3 cells),as well as in the APP/PS1 mouse model.Additionally,injection of APP/PS1 mice with an adeno-associated virus encoding GGT5 enhanced hippocampal synaptic plasticity and mitigated cognitive deficits.Interestingly,increasing GGT5 expression in cerebrovascular endothelial cells reduced levels of both soluble and insoluble amyloid-βin the brains of APP/PS1 mice.This effect may be attributable to inhibition of the expression ofβ-site APP cleaving enzyme 1,which is mediated by nuclear factor-kappa B.Our findings demonstrate that GGT5 expression in cerebrovascular endothelial cells is inversely associated with Alzheimer’s disease pathogenesis,and that GGT5 upregulation mitigates cognitive deficits in APP/PS1 mice.These findings suggest that GGT5 expression in cerebrovascular endothelial cells is a potential therapeutic target and biomarker for Alzheimer’s disease.

Helicobacter pylori gamma-glutamyl transpeptidase and its pathogenic role

Helicobacter pylori(H.pylori)gamma-glutamyl transpeptidase(GGT)is a bacterial virulence factor that converts glutamine into glutamate and ammonia,and converts glutathione into glutamate and cysteinylglycine.H.pylori GGT causes glutamine and glutathione consumption in the host cells,ammonia production and reactive oxygen species generation.These products induce cell-cycle arrest,apoptosis,and necrosis in gastric epithelial cells.H.pylori GGT may also inhibit apoptosis and induce gastric epithelial cell proliferation through the induction of cyclooxygenase-2,epidermal growth factor-related peptides,inducible nitric oxide synthase and interleukin-8.H.pylori GGT induces immune tolerance through the inhibition of T cell-mediated immunity and dendritic cell differentiation.The effect of GGT on H.pylori colonization and gastric persistence are also discussed.

Association of serum gamma-glutamyl transferase with treatment outcome in chronic hepatitis B patients

AIM:To investigate the association of serum gammaglutamyl transferase(GGT) levels with chronic hepatitis B infection and hepatitis B e antigen(HBe Ag) seroconversion.METHODS:A retrospective study was performed on clinical data collected from patients who had been positive for hepatitis B surface antigen for > 6 mo and who were antiviral-treatment na?ve(n = 215) attending the Hepatitis Clinic at Nanjing Drum Tower Hospital between August 2010 and December 2013. Healthy individuals without liver disease(n = 83) were included as controls. Patients were categorized into four groups based on disease status as recommended by the European Association for the Study of the Liver:immune tolerance(IT; n = 47),HBe Ag-positive hepatitis(EPH; n = 93),HBe Ag-negative hepatitis(ENH;n = 20),and inactive carrier(IC; n = 55). Prediction of complete response(CR) based on serum GGT was also examined in EPH patients(n = 33) treated for 48 wk with nucleos(t)ide analogue(NA) therapy,including lamivudine plus adefovir combination therapy(n = 20) or entecavir monotherapy(n = 13). CR was defined as a serum hepatitis B virus DNA level < 500 copies/m L and HBe Ag seroconversion by 48 wk of treatment. RESULTS:Serum GGT levels were significantly increased in EPH and ENH patients relative to the IT,IC,and healthy control groups(P < 0.01 for all). However,no significant difference in serum GGT levels was found between the EPH and ENH groups. Baseline serum GGT levels were significantly higher in patients who achieved CR(7/33; 21.2%) compared to patients in the non-CR group(26/33; 78.8%; P = 0.011). In addition,the decline in serum GGT was greater in CR patients compared to non-CR patients after 24 wk and 48 wk of treatment(P = 0.012 and P = 0.008,respectively). The receiver operating characteristic curve yielded a sensitivity of 85.71% and a specificity of 61.54% at a threshold value of 0.89 times the upper limit of normal for baseline serum GGT in the prediction of CR following NA therapy. CONCLUSION:Serum GGT is significantly elevated in EPH and ENH patients and is a potential biomarker for the prediction of HBe Ag seroconversion following NA therapy.

Serum Gamma-glutamyl Transferase Levels Predict Functional Outcomes after Aneurysmal Subarachnoid Hemorrhage

Objective We aim to explore the potential association between serum gamma-glutamyl transferase levels and functional outcome after aneurysmal subarachnoid hemorrhage in a Chinese population. Methods A total of 386 aneurysmal subarachnoid hemorrhage patients were included in the study from September 2007 to February 2015. Baseline serum gamma-glutamyl transferase levels and 6-month follow-up functional outcomes were determined. A poor outcome was defined as a modified ranking scale score of ≥ 3. The multivariable logistic model was used to analyze the relationship between serum gamma-glutamyl transferase and clinical outcomes after aneurysmal subarachnoid hemorrhage. Results The adjusted poor outcome rates of patients with gamma-glutamyl transferase levels of 〈 30 U/L, 30-50 U/L and ≥ 50 U/L were 16.7%, 19.6%, and 34.4%, respectively （P 〈 0.01）. The age-sex and multivariable adjusted odds ratios （95% confidence intervals） of poor prognosis comparing the top group （≥ 50 U/L） with the lowest group （〈 30 U/L） were 5.76 （2.74-12.13）, 6.64 （2.05-21.52）, and 6.36 （1.92-21.02）. A significant linear trend existed between gamma-glutamyl transferase level and aneurysmal subarachnoid hemorrhage prognosis. This association was also observed among nondrinkers. Conclusion Patients with higher gamma-glutamyl transferase levels were more likely to have a poor prognosis. Serum gamma-glutamyl transferase can be considered to be an independent predictor of functional outcomes after aneurysmal subarachnoid hemorrhage.

Genetic Mutation of Vitamin K-dependent Gamma-glutamyl Carboxylase Domain in Patients with Calcium Oxalate Urolithiasis

To investigate the exon mutation of vitamin K-dependent gamma-glutamyl carboxylase （GGCX or VKDC） in patients with calcium oxalate urolithasis, renal cortex and peripheral blood samples were obtained from severe hydronephrosis patients （with or without calculi）, and renal tumor patients undergoing nephrectomy. GGCX mutations in all 15 exons were examined in 44 patients with calcium oxalate urolithiasis （COU） by polymerase chain reaction （PCR） and denatured high pressure liquid chromatography （DHPLC）, and confirmed by sequencing. Mutation was not found in all COU samples compared to the controls. These data demonstrated that functional GGCX mutations in all 15 exons do not occur in most COU patients. It was suggested that there may be no significant association between the low activity and mutation of GGCX in COU.

Effect of <i>Lactobacillus brevis</i>SBC8803 on Gamma-Glutamyl Transferase in Japanese Habitual Drinkers: A Double-Blind, Placebo-Controlled Study

A randomized, double-blind, placebo-controlled clinical trial in Japanese habitual drinkers was conducted to evaluate the efficacy of Lactobacillus brevis SBC8803 to alleviate adverse effect of alcohol. Subjects who drank habitually and had moderately higher levels of gamma-glutamyl transferase (GGT) (50 - 100 IU/L) were enrolled. The levels of transaminases in these subjects were almost within normal levels (aspartate transaminase (AST) <30 IU/L and alanine transaminase (ALT) <40 IU/L). Either the capsules containing placebo (n = 23) or 130 mg (4.0 × 1010 colony-forming units) of live L. brevis SBC8803 (n = 22) per day were administered for the continuous eight weeks (56 days). During the period, the subjects both in test group and placebo groups have kept each drinking behavior as usual. Regarding lipid metabolism, triacylglycerol (TG) levels in the male test group significantly decreased at week 4 as compared with week 0. Biomarkers of hepatocytes-damage;AST and ALT levels showed no significant differences between the pla- cebo and test groups at both weeks 4 and 8. Oxidative stress marker;GGT at weeks 4 was significantly lower in the test group than that in the placebo group (p = 0.017), but not at weeks 8. However, taking a reduced rate of GGT at weeks 8 comparing with that at week 0, that in the test group showed larger value comparing with that in the placebo group. These data about TG and GGT suggest that, although efficacy of L. brevis SBC8803 is limited in this study, intake of the probiotic may alleviate alcoholic influence in lipid metabolism and oxidative stress.

The Micro-determination of Serum Gamma-Glutamyl Transferase

The method of serum gamma-glutamyl transferase colorimeter assay was modified by changing the wave length from 420 nm to 400 nm, the incubated temperature from 37℃ to 50℃, the sample amount from 30 μl to 6μl. The modified method was proved to be more sensitive, with CV of intra-group being 2. 06% and accuracy 97. 4%. The method is suitable for clinical application with small-amount blood samples collected frorri earlobe or finger tip.

肝功能相关指标联合胆囊收缩率在诊断胆道闭锁中的应用价值

目的探讨γ-谷氨酰转移酶(gamma-glutamyl transferase,GGT)、直接胆红素(direct bilirubin,DBil)与胆囊收缩率在诊断胆道闭锁(biliary atresia,BA)中的应用价值。方法收集2017年9月至2021年9月在西安交通大学附属儿童医院及西安市中心医院儿科住院治疗的185例胆汁淤积性肝病患儿为研究对象,根据剖腹探查或术中胆道造影和随访情况,将患儿分为BA组(70例)和肝内胆汁淤积(intrahepatic cholestasis,IHC)组(115例)。比较两组患儿的一般临床资料、实验室检查指标[包括总胆红素(total bilirubin,TBil)、DBil、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、GGT、碱性磷酸酶(alkaline phosphatase,ALP)、总胆汁酸(total bile acid,TBA)]及腹部超声检查资料。将有统计学意义的指标纳入受试者工作特征(receiver operator characteristic,ROC)曲线分析,计算ROC曲线下面积、最佳诊断界值和OR值;应用MedCalc软件进行ROC曲线下面积对比,分析各指标对诊断BA的价值。结果BA组和IHC组患儿的性别(男/女:31例/39例比78例/37例)、就诊年龄(中位数:52.0 d比58.0 d)、肝脏肋下大小(中位数:4.0 cm比2.0 cm)、脾大比例[40%(28/70)比18.3%(21/115)]、大便颜色、TBil(中位数:204.35μmol/L比138.30μmol/L)、DBil(中位数:125.70μmol/L比80.00μmol/L)、ALT(中位数:112.00 U/L比71.00 U/L)、AST(中位数:175.00 U/L比120.00 U/L)、GGT(中位数:440.75 U/L比94.50 U/L)、餐后1 h胆囊收缩率(无收缩/有收缩且<50%/有收缩且>50%:52.9%/41.4%/5.7%比7.0%/27.8%/65.2%)差异有统计学意义(P均<0.05)。两组患儿ALP(中位数526.00 U/L比548.00 U/L)、TBA(中位数:143.45μmol/L比161.90μmol/L)和25羟维生素D(中位数:8.00 ng/ml比8.13 ng/ml)水平差异无统计学意义(P均>0.05)。多因素Logistic回归分析表明,DBil(OR=1.031,95%CI:1.015~1.047,P<0.001)、GGT(OR=1.007,95%CI:1.004~1.011,P<0.001)、餐后1 h胆囊无收缩(OR=57.493,95%CI:9.577~345.133,P<0.001)和胆囊收缩率<50%(OR=9.907,95%CI:1.828~53.710,P=0.008)均为BA的危险因素。TBil、DBil、ALT、AST、GGT、GGT+DBil、GGT+DBil+胆囊收缩率诊断BA的ROC曲线下面积分别为0.797、0.820、0.614、0.658、0.890、0.932和0.963。单项指标中GGT的ROC曲线下面积最大,当GGT超过界值173.20 U/L时诊断BA的敏感度、特异度、阳性似然比、阴性似然比和诊断比值比分别为84.3%、78.3%、3.885、0.201和19.328。GGT+DBil+胆囊收缩率联合对BA的诊断价值最高,ROC曲线下面积显著高于GGT+DBil(z=2.303,P=0.021),其诊断BA的敏感度、特异度、阳性似然比、阴性似然比和诊断比值比分别为90.0%、90.4%、9.375、0.111和84.459。结论GGT、DBil与胆囊收缩率联合对BA有较高的诊断价值,当GGT超过界值173.20 U/L、DBil超过界值97.05μmol/L且超声提示胆囊收缩不良时需高度警惕BA。

血清镁离子浓度与直肠癌患者谷氨酰转肽酶的关系

直肠癌患者血清镁离子(Mg^(2+))浓度对γ-谷氨酰转肽酶(γ-GT)的影响尚不明确,收集分析临床数据,Mg^(2+)浓度不呈正态分布(D=0.737,P<0.05),按照中位数分组,比较不同组间临床病理特征的差异,用局部加权散点平滑(LOWESS)、分段线性回归方法,拟合血清Mg^(2+)浓度与γ-GT的关系。结果发现,与Mg^(2+)浓度小于0.92 mmol/L组的直肠癌患者比较,Mg^(2+)浓度≥0.92 mmol/L组的γ-GT和血清总胆固醇较高(P均<0.05)。LOWESS的结果表明,原始数据中血清Mg^(2+)浓度的两个变化点分别为0.92 mmol/L和0.99 mmol/L,自然对数转换的数据中血清Mg^(2+)浓度的另外两个变化点分别为-0.167和-0.01。利用原始数据建立的两段线性回归模型表明,血清Mg^(2+)浓度的变化点为0.98 mmol/L,Mg^(2+)浓度<0.98 mmol/L对γ-GT有正向影响,Mg^(2+)≥0.98 mmol/L时有负向影响。另一个使用自然对数转换数据的两段线性回归模型显示,血清Mg^(2+)浓度的变化点为0.01,其中Mg^(2+)浓度的自然对数<0.01对γ-GT有正向影响,当Mg^(2+)浓度的自然对数≥0.01时则有负向影响。用原始数据LOWESS回归的2个拐点,即0.92 mmol/L和0.99 mmol/L的Mg^(2+)浓度,进行三段线性回归分析,结果显示,<0.980 mmol/L的Mg^(2+)浓度,对γ-GT的影响是正向的,且与<0.929 mmol/L的Mg^(2+)浓度区间的系数不同,影响程度不同,而在≥0.980 mmol/L的Mg^(2+)浓度区间,对γ-GT的影响是负向的,此外,用对数转换数据LOWESS的2个拐点进行的三段线性回归,也显示Mg^(2+)浓度的自然对数以-0.020为分界点时,对γ-GT的影响方向是相反的,但三段线性回归模型均没有统计学意义,总之,具有较高Mg^(2+)浓度的直肠癌患者,其γ-GT的水平也较高,Mg^(2+)浓度对γ-GT的影响存在拐点效应,为γ-GT的关联因素研究提供了基础。

Serum Gamma-glutamyl Transferase Concentration Within the Reference Range is Related to the Coronary Heart Disease Risk Prediction in Korean Men： Analysis of the Korea National Health and Nutrition Examination Survey （V-1, 2010 and V-2, 2011）

Background：Limited data exist on the association of serum gamma-glutamyl transferase （GGT） level within the reference range with the increased risk of coronary heart disease （CHD） prediction in men.The study examined the association between serum GGT concentration within the reference range and the CHD risk prediction in Korean men.Methods：The study employed data from Korean National Health and Nutrition Examination Survey （V-1,2010 and V-2,2011） where a total of 1301 individuals were analyzed.A 10-year CHD risk prediction was computed using the Framingham Risk Score （FRS） modified by the National Cholesterol Education Program （NCEP） Adult Treatment Panel Ⅲ （ATP Ⅲ）.Results：Positive correlations were established between log-transformed GGT concentration and FRS （r =0.237,P 〈 0.001）.After adjustment of body mass index,the amount of alcohol intake and low-density lipoprotein-cholesterol,the odds ratio （95% confidence interval） for intermediate risk and beyond of 10-year CHD prediction （10-year risk ≥10%） with lowest quartile of participants was 1.21 （0.78-1.87） for second quartiles,1.39 （0.88-2.21） for third quartiles and 2.03 （1.23-3.34） for highest quartiles.Conclusions：Higher serum GGT within its reference range was significantly correlated with a 10-year CHD risk prediction estimation using NCEP ATP Ⅲ in Korean men.

Gamma-glutamyl Transpeptidase to Platelet Ratio Predicts Liver Injury in Hepatitis B e Antigen-negative Chronic Hepatitis B Patients With Normal Alanine Aminotransferase

Background and Aims:Chronic hepatitis B virus(HBV)infection is a serious health problem worldwide.Evaluating liver injury in patients with hepatitis B e antigen(HBeAg)-negative chronic hepatitis B(CHB)with detectable HBV DNA and normal alanine aminotransferase(ALT)is crucial to guide their clinical management.We aimed to investigate the stages of liver inflammation and fibrosis as well as the predictive accuracy of gamma-glutamyl transpepti-dase-to-platelet ratio(GPR)in these patients.Methods:A total of 184 treatment-naïve HBeAg-negative CHB pa-tients with detectable HBV DNA and normal ALT were enrolled.The Scheuer scoring system was used to classify liver inflammation and fibrosis.Results:The distribution of patients with different liver inflammation grades were as follows:G0,0(0%);G1,97(52.7%);G2,68(37.0%);G3,12(6.5%);and G4,7(3.8%).The distribution of patients with different liver fibrosis stages were as follows:S0,22(12.0%);S1,72(39.1%);S2,42(22.8%);S3,19(10.3%);and S4,29(15.8%).The areas under the re-ceiver operating characteristic(AUROC)curves of GPR in predicting significant inflammation,severe inflammation,and advanced inflammation were 0.723,0.895,and 0.952,respectively.The accuracy of GPR was significantly superior to that of ALT in predicting liver inflammation.The AUROCs of GPR in predicting significant fibrosis,severe fibrosis,and cirrhosis were 0.691,0.780,and 0.803,respectively.The predictive accuracy of GPR was significantly higher than that of aminotransferase-to-platelet ratio index(APRI)and fibrosis index based on four factors(FIB-4)in identifying advanced fibrosis and cirrhosis,and it was superior to FIB-4 but comparable to APRI in identifying significant fibrosis.Conclusions:Nearly half of the HBeAg-negative CHB patients with detectable HBV DNA and normal ALT levels had significant liver inflammation or fibrosis.GPR can serve as an accurate predictor of liver inflammation and fibrosis in these patients.

The clinical implication of gamma-glutamyl transpeptidase in COVID-19

Background and aim:Coronavirus disease 2019(COVID-19)is a life-threatening disease that predomi-nantly causes respiratory failure.The impact of COVID-19 on other organs remains elusive.Herein,we aimed to investigate the effects of COVID-19 on the hepatobiliary system.Methods:In the current study,we obtained the clinical records and laboratory results from 66 laboratory-confirmed patients with COVID-19 at the Wuhan Tongji Hospital between 10 February 2020 and 28 February 2020.The detailed clinical features and laboratory findings were collected for analysis.Bioinformatics analysis was conducted to evaluate the correlation between gamma-glutamyl transferase(GGT)and severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)entry receptor angiotensin-converting enzyme 2(ACE2).Results:In this cohort,30(51.7%)patients had abnormal liver function on admission,which was asso-ciated with disease severity and enriched in the male and diabetic patients.The elevated levels of direct bilirubin(P¼0.029)and GGT(P¼0.004)were common in patients with severe pneumonia when compared with those with mild pneumonia.In addition,elevated levels of GGT(P¼0.003)and aspartate aminotransferase(AST)(P¼0.007)were positively associated with longer hospital stay.The expression of ACE2 was closely associated with GGT in various human tissues because they shared the common transcriptional regulator hepatic nuclear factor-1 b(HNF1B).Conclusions:Increased GGT levels were common in severe cases and elevated GGT levels were positively associated with prolonged hospital stay and disease severity.Due to the consistent expression with ACE2,GGT is a potent biomarker indicating the susceptibility of SARS-CoV-2 infection.

Gamma-glutamyl transferases： A structural, mechanistic and physiological perspective

Gamma glutamyl transferases （GGT） are highly conserved enzymes that occur from bacteria to humans. They remove terminal y-glutamyl residue from peptides and amides. GGTs play an important role in the homeostasis of glutathione （a major cellular antioxidant） and in the detoxification of xenobiotics in mammals. They are implicated in diseases like diabetes, inflammation, neurodegenerative diseases and cardiovascular diseases. The physiological role of GGTs in bacteria is still unclear. Nothing is known about the basis for the strong conservation of the enzyme across the living system. The review focuses on the enzyme＇s physiology, chemistry and structural properties of the enzyme with emphasis on the evolutionary relationships. The available data indicate that the members of the GGT family share common structural features but are functionally heterogenous.

PT和γ-GT/Alb比值对慢性乙型肝炎患者肝纤维化分期的预测价值

目的:评估凝血酶原时间(PT)、γ-谷氨酰转肽酶/白蛋白(γ-GT/Alb)比值对慢性乙型肝炎(CHB)患者肝纤维化分期的预测价值,并与经典无创模型天冬氨酸氨基转移酶/血小板比值指数(APRI)评分、4因子模型(FIB-4)进行对比。方法:收集2020年4月至2021年5月北京中医药大学东方医院收治的108例CHB肝纤维化患者病例资料作回顾性分析,根据肝活检病理结果将患者分为无或轻度肝纤维化组(S0~S1期,68例)、显著肝纤维化组(≥S2期,40例)。收集患者的血清学指标、APRI、FIB-4等数据,运用单因素分析、多因素logitstic回归分析筛选出独立预测指标并建立综合预测模型,同时采用受试者工作特征曲线(ROC)评价综合模型的预测准确性。结果:单因素分析结果显示,两组患者在γ-GT、Alb、γ-GT/Alb、PT、LN、PLT方面比较,差异具有统计学意义(均P<0.05);多因素logitstic回归分析结果显示,PT和γ-GT/Alb是显著肝纤维化的独立预测指标(P<0.05)。依据logistic回归分析结果建立综合预测模型[logit(P)=-4.926+0.048×γ-GT/Alb+0.147×PT],其ROC曲线下面积(AUC)为0.839,截断值为0.469时,敏感度为78.04%,特异度为97.09%。预测肝纤维化的准确性明显优于APRI及FIB-4,差异有统计学意义(P<0.05)。结论:PT和γ-GT/Alb的综合预测模型对预测CHB导致的显著肝纤维化(≥S2)具有优势,其预测准确性均高于APRI、FIB-4两项指标。

2型糖尿病合并OSAHS患者AHI与同型半胱氨酸和肝酶的相关性

目的探讨2型糖尿病(T2DM)合并睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠呼吸暂停低通气指数(AHI)与同型半胱氨酸(Hcy)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT)之间的关系研究。方法选取住院T2DM患者216例,依据AHI分为A组单纯T2DM(AHI<5共49例);B1组T2DM合并轻、中度OSAHS(AHI 5~30共119例);B2组T2DM合并重度OSAHS(AHI>30共48例),分析AHI与Hcy、肝酶的关系。结果Hcy水平B2组高于B1组和A组,组间比较差异均有统计学意义(P<0.05);B1组较A组Hcy水平有升高趋势,但组间比较差异无统计学意义(P>0.05)。GGT水平B2组高于B1组,B1组高于A组,3组间两两比较差异均有统计学意义(P<0.05)。ALT水平B2组高于B1组和A组,组间比较差异均有统计学意义(P<0.05);B1组较A组ALT水平有升高趋势,但组间比较差异无统计学意义(P>0.05)。随AHI升高3组AST水平有升高趋势,但3组间两两比较差异均无统计学意义(P>0.05)。分别以Hcy、GGT、ALT、AST为因变量,行多元线性回归分析,结果显示AHI与T2DM合并OSAHS患者Hcy、GGT独立相关。结论OSAHS会致T2DM患者Hcy及肝酶水平升高,AHI是Hcy、GGT的独立危险因素,提示OSAHS增加T2DM患者心脑血管疾病风险及早期肝损伤,T2DM患者应重视OSAHS筛查和治疗并适时补充叶酸。

非侵入性肝纤维化评分在肝硬化并食管胃底静脉曲张严重程度预测中的运用

目的 评估无创检查预测食管静脉曲张严重程度及出血的可能性。方法 收集2021年1月至2022年5月包头医学院第二附属医院86例肝病患者的临床资料,包括实验室检查、影像学检查、胃镜检查。根据胃镜检查评估食管静脉曲张严重程度。APRI、GPR、FIB-4、S-index、AAR、GAPRI对肝硬化伴食管静脉曲张出血严重程度的预测价值。结果 APRI、GPR、FIB-4、S-index、AAR、GAPRI评估肝硬化食管胃底静脉曲张出血严重程度的曲线下面积分别为0.646、0.637、0.634、0.632、0.566、0.636,特异度分别56.72%、89.74%、36.84%、73.68%,57.89%、89.47%,敏感度分别为56.72%、40.30%、91.04%、55.22%、61.19%、40.30%。食管静脉曲张轻度组中血小板、ALT、RDW分别为(114.47±50.71)×109、(34.74±15.81)U/L、(16.889±2.252),严重组为(95.79±42.27)×10^(9)、(42.52±24.97)U/L、(15.849±2.602),差异均无统计学意义(P>0.05)。轻度组APRI、FIB-4、S-index、 GAPRI、 GPR、AAR分别为0.637(0.409,0.895)、0.637(0.409,0.895)、3.562(2.166,6.155)、0.435(0.211,0.984)、43.810(26.829,64.021)、0.730(0.447,1.067)、1.555±0.623,严重组分别为0.901(0.524,1.407)、0.901(0.524,1.407)、4.5(3.335,6.991)、0.891(0.327,1.778) 61.000(29.126,144.444)、1.017(0.485,2.407)、1.482±0.720,差异无统计学意义(P>0.05)。结论 APRI、GPR、GAPRI、S-index对肝硬化伴食管静脉曲张出血严重程度有一定预测价值,其中APRI预测价值更大。

血清GGT、TBil、TG与胆囊结石并胆总管结石内镜术后胆总管结石复发的关联性研究

目的探讨胆囊结石并胆总管结石内镜术后血清γ-谷氨酰转移酶(GGT)、总胆红素(TBil)、甘油三酯(TG)与胆总管结石复发的相关性,分析其对术后复发的预测价值。方法选取2020年2月至2022年3月于河南中医药大学第五临床医学院(郑州人民医院)行内镜取石术的80例胆囊结石并胆总管结石患者为研究对象,依据术后1年复发情况分为复发组22例、未复发组58例。比较两组基线资料及术前、术后3个月、术后6个月血清GGT、TBil、TG水平。分析血清各指标水平与生化指标相关性,并分析术后3个月、6个月对术后复发的预测价值。比较术后6个月血清各指标不同水平者复发风险。结果术后3个月、6个月两组血清GGT、TBil、TG水平低于术前,且复发组高于未复发组(P<0.05);GGT、TBil、TG与生化指标密切相关(P<0.05);术后3个月、6个月时,联合预测术后复发的曲线下面积(AUC)大于单项预测(P<0.05);GGT、TBil、TG高水平者术后复发危险度分别是低水平的1.685倍、1.743倍、1.608倍(P<0.05)。结论血清GGT、TBil、TG与胆囊结石并胆总管结石内镜术后复发密切相关,联合检测其水平对术后复发具有一定预测价值。

血清甲胎蛋白、γ-谷氨酰转肽酶对肝细胞癌发生微血管侵犯的临床应用价值

目的:基于放射学特征和临床实验室数据构建肝细胞癌(hepatocellular carcinoma,HCC)患者发生微血管侵犯(microvascular invasion,MVI)的预测模型,探讨HCC患者术前甲胎蛋白(alpha-fetoprotein,AFP)和γ-谷氨酰转肽酶(gamma-glutamyl transferase,GGT)的临床应用价值。方法:回顾性地收集南京医科大学第一附属医院479例HCC手术切除患者的临床数据,使用Logistics回归分析确定与MVI显著相关的变量,建立模型并绘制列线图。使用受试者工作特征曲线下面积(area under curve,AUC)、校准曲线和决策曲线分析(decision curve analysis,DCA)来评估模型的预测性能。通过灵敏度、特异度和准确度分析对模型预测性能进行比较。应用Kaplan-Meier曲线来评估患者的生存概率。结果:在多因素分析中,肿瘤大小、肿瘤边界不清楚、肿瘤外生性生长、AFP和GGT是HCC患者发生MVI的独立危险因素,用于构建模型。有AFP和GGT的模型A比没有AFP和GGT的模型B表现出更好的预测性能,AUC分别为0.902(0.872~0.932)和0.876(0.842~0.909)。分析评估模型临床净收益的DCA显示出模型A略好于模型B,都具有良好的临床应用价值。模型在队列中显示出良好的识别能力,预测的概率与实际观测值具有较好的一致性。在生存分析中发现,AFP和GGT升高的患者预后明显差于未升高的患者。结论:建立了HCC患者发生MVI的预测模型,研究证实了血清AFP和GGT的临床应用价值。

血清PTX-3、γ-GGT与冠心病及冠脉狭窄程度的相关性分析

目的探讨正五聚蛋白3(pentraxin,PTX-3)和γ-谷氨酰转肽酶(gamma-glutamyl transferase,γ-GGT)在评估冠心病(Coronary Heart Disease,CHD)及冠状动脉狭窄程度的潜在价值,评估两者联合检测对CHD早期诊断的临床意义.方法通过冠状动脉造影(CAG)定量测量Gensini(GS)评分方法评价冠脉狭窄程度.选取75例首次行CAG确诊为CHD的患者为试验组(CHD组),同时选取30例CAG结果阴性的患者为对照组,其中试验组根据GS评分系统依次分为低分组(24例)、中分组(24例)及高分组(27例).入院后采取酶联免疫吸附法(ELISA法)测定PTX-3水平,应用全自动生化分析仪检测所有纳入研究患者的血清γ-GGT水平,比较各组血清PTX-3、γ-GGT水平差异及两者联合检测对CHD早期诊断和冠脉狭窄程度的价值.结果随着CHD冠脉狭窄程度的增高,血清PTX-3、γ-GGT水平依次升高,即高分组>中分组>低分组>对照组(P<0.001).结论PTX-3、γ-GGT在CHD患者血清中显著升高,且与GS评分呈显著正相关关系;PTX-3、γ-GGT联合检测有可能成为冠心病早期诊断和危险分度的血清学标志物.