多项生化指标联合检测在肝脏疾病中的临床应用研究  

The clinical value of combined biochemical tests in detecting liver diseases

作　　者：阴斌霞[1] 王香玲[1] 赵丽华[1] 柴丽华[1] 岳天海[1] 何谦[1] 李丽华[1] 刘军[1] 

机构地区：[1]西安交通大学医学院第二附属医院检验科,西安710004

出　　处：《诊断学理论与实践》2007年第6期540-544,共5页Journal of Diagnostics Concepts & Practice

摘　　要：目的:探讨多项生化指标联合检测在不同肝脏疾病诊断与治疗中的意义。方法:应用全自动生化分析仪测定170例不同肝病患者血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(γ-GT)、腺苷脱氨酶(ADA)、α-L-岩藻糖苷酶(AFU)、单氨氧化酶(AMO)、胆碱酯酶(CHE)、甘氨酰脯氨酸二肽氨基肽酶(GPDA)、同型半胱氨酸(Hcy)、线粒体型AST同工酶(m-AST)、前白蛋白(PAB)、总胆汁酸(TBA)、5′-核苷酸酶(5′-NT)等14项生化指标,观察不同肝病组各生化指标的变化。结果:不同肝病患者血清中各项生化指标与正常对照相比,除慢性活动性肝炎(CAH)、肝硬化(LC)组GPDA无显著差异,肝细胞肝癌(HCC)组中PAB无显著差异(P>0.05)外,其余指标均有显著差异(P<0.01)。不同肝病组各项生化指标的检测阳性率不同,各组阳性率前5位的指标是:急性黄疸性肝炎(AIH):ALT>AST>m-AST>Hcy>AMO;慢性迁延性肝炎(CPH):AMO>ALT>AST>m-AST>Hcy;CAH:AST>AMO>m-AST>ALT>Hcy;重症肝炎(FH):Hcy>TBA>m-AST>AMO>AST;LC:AMO>CHE>PAB>5′-NT>Hcy;HCC:AFU>GPDA>γ-GT>ALP>m-AST。将前5位的生化指标联合检测,诊断阳性检出率均有提高。AIH组和FH组,阳性检出率100%;CPH组阳性检出率由66.7%提高至77.8%;CAH组由79.3%提高至86.2%;LC组由84.0%提高至92.0%;HCC组由85.0%提高至95.0%。结论:采用多项生化指标联合检测,能充分利用各项目的特异性和互补性,弥补单一生化指标检测的局限性,提高阳性检出率,对肝脏疾病的诊断、治疗及预后判断有一定指导意义。Objective To analyze the clinical value of multiple biochemical tests in detecting liver diseases. Methods The levels of multiple biochemical indicators including ALT, AST, ALP, γ-GT, ADA, AFU, AMO, CHE, GPDA, Hcy, m-AST, PAB, TBA and 5′-NT were measured by panautomatic biochemical analyzer in 170 patients with different liver diseases, and the 170 patients were divided into groups of acute icterus hepatitis （AIH）, chronic persisting hepatitis （CPH）, chronic active hepatitis （CAH）, fulminant hepatitis （FH）, liver cirrhosis （LC） and hepatocellular carcinoma （HCC） based on their liver disease. Results Comparing with the normal levels, all the results of the different groups were obviously abnormal （P〈0.01） except GPDA in the CAH group and LC group, PAB in the HCC group （P〉0.05）. The highest rate of five positive tests in the groups were ALT 〉AST 〉m-AST 〉 Hcy〉 AMO at the AIH group;AMO〉 ALT〉 AST〉 m-AST〉 Hcy at the CPH group;AST〉 AMO〉 m-AST〉 ALT 〉Hcy at the CAH group;Hcy 〉 TBA〉 m-AST〉 AMO 〉AST at the FH group;AMO〉 CHE 〉 PAB 〉5′-NT 〉Hcy at the LC group;AFU 〉 GPDA〉γ-GT〉 ALP〉 m-AST at the HCC group. The first five positive tests with the highest rate were conbined to measure, the positive rate increased in all the groups, and it reached 100% in the AIH and FH groups; from 66.7% to 77.8% in the CPH group; form 79.3% to 86.2% in the CAH group; from 84.0% to 92.0% in the LC group; and from 85.0% to 95.0% in the HCC group. Conclusions Combined examination of multiple biochemical tests could increase positive detective rate in patients with liver disease and has higher value in guiding diagnosis, therapy and prediction of liver disease.

关 键 词：生化检测 联合检测 肝脏疾病 

分 类 号：R575.1[医药卫生—消化系统]