常规生化指标评估慢性肝功能损害的临床应用价值  

Clinical Value of Conventional Biochemical Tests for Appraising Chronic Liver Damage

作　　者：张洁[1] 曹芸[1] 王之青[1] 张美华[1] 谈晴云[1] 于嘉屏[1] 

机构地区：[1]上海交通大学医学院附属仁济医院检验科,200001

出　　处：《胃肠病学》2008年第10期620-622,共3页Chinese Journal of Gastroenterology

基　　金：上海市科学技术委员会(No.06ZR14063)资助

摘　　要：背景:目前国内用于诊断慢性肝功能损害的血清学检测指标很多,但对其诊断效率进行客观评价的研究并不多。目的:采用受试者工作特征曲线(ROC曲线)和诊断性能指标对常用的7项血清学指标进行综合分析,探讨其临床应用价值。方法:检测肝硬化组(n=81)、慢性肝病组(n=43)和健康对照组(n=30)的血清白蛋白(ALB)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、腺苷脱氨酶(ADA)、5’-核苷酸酶(5’-NT)、胆碱酯酶(ChE)等7个生化指标,应用ROC曲线进行分析,评价各指标的敏感性和特异性,观察不同肝病组上述指标的变化情况。结果:与慢性肝病组和健康对照组相比,肝硬化组ALB、ChE显著下降,AST显著升高(P<0.05);ROC曲线下面积ALB最高,ChE次之。7项指标中ChE的敏感性和特异性最高,分别为93.8%和83.7%;诊断准确率ChE最高,达90.3%,ALB次之,为89.5%。结论:临床常规的7项生化指标中,ALB和ChE最能反映肝硬化特别是肝硬化失代偿期肝功能损害程度。At present, there are numerous serological tests for appraising chronic liver damage, but studies on the objective evaluation of these tests are scarce. Aims： The clinical value of 7 conventional biochemical tests for assessing chronic liver damage were appraised by receiver operating characteristic （ROC） curves and their diagnostic performance index. Methods： In patients with three groups, i.e. liver cirrhosis group （n=81）, chronic liver disease group （n=43） and healthy control group （n=30）, 7 conventional biochemical tests were performed, namely： serum albumin （ALB）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, lactate dehydrogenase （LDH）, adenosine deaminase （ADA）, 5＇- nucleotidase （5＇-NT）, and cholinesterase （ChE）. ROC curves were used to evaluate the sensitivity and specificity of these tests, and the variation of results of these tests among the three groups was observed. Results： Compared with chronic liver disease group and healthy control group, serum ALB and ChE decreased significantly and AST increased significantly in liver cirrhosis group （P〈0.05）. The area under ROC curve was the highest in ALB, ChE being the next. Of the seven biochemical tests, both the sensitivity and specificity of ChE were the highest, 93.8% and 83.7%, respectively. The accurate diagnosis rate of ChE was 90.3%, followed by ALB （89.5%）. Conclusions： Of the 7 conventional biochemical tests, ALB and ChE could best reflect the degree of liver damage in cirrhotic patients, especially in those with liver decompensation.

关 键 词：肝疾病 血清学 评价研究 ROC曲线 敏感性与特异性 

分 类 号：R575[医药卫生—消化系统] R446.1[医药卫生—内科学]