12项肝酶学指标在肝病诊断中的意义及临床价值评价的研究  

Study on Diagnostic Value of Determination of Liver Enzymology in Liver Disease

作　　者：罗蓉[1] 王伟[1] 李卓成[1] 熊鹰[2] 

机构地区：[1]深圳市第二人民医院检验科,广东深圳518035 [2]深圳市第二人民医院消化科,广东深圳518035

出　　处：《深圳中西医结合杂志》2009年第2期90-95,共6页Shenzhen Journal of Integrated Traditional Chinese and Western Medicine

基　　金：深圳市科技计划项目(200703168)

摘　　要：目的:了解N–乙酰–β–D氨基葡萄糖苷酶(NAG)、α–岩藻糖苷酶(AFU)、亮氨酸氨基肽酶(LAP)、天冬氨酸氨基转移同工酶(ASTm)、谷氨酸脱氢酶(GLDH)、腺苷脱氨酶(ADA)、血清天冬氨酸转氨基酶(AST)、丙氨酸转氨基酶(ALT)、碱性磷酸酶(ALP)、γ–谷氨酰转肽酶(GGT)、5'–核苷酸酶(5'–NT)及血清胆碱酯酶(CHE)等12项肝酶学指标在肝病诊断和治疗中的价值。方法:采用全自动生化分析仪对308例各种肝病患者和115例正常人血清中的上述指标进行检测和分析。结果:急性肝炎时NAG、AFU、LAP、ASTm、GLDH、ADA、AST、ALT、ALP、GGT和5'–NT均显著增高,ALT、LAP、AFU、ASTm、AST和ALP的AUC分别为0.875、0.861、0.853、0.830、0.825和0.725,阳性率分别为100%、93.8%、78.1%、87.5%、100%和68.8%;肝硬化时NAG、LAP、ASTm、GLDH、ADA、AST、ALP、GGT和5'–NT均显著升高,CHE显著降低,ADA、AST、5'–NT、GGT和CHE的AUC分别为0.764、0.761、0.752、0.748和0.721,阳性率分别为91.2%、73.5%、67.6%、75.0%和61.8%;重型肝炎时NAG、AFU、ASTm、GLDH、ADA、AST、ALT、ALP、GGT和5'–NT均显著增高,CHE显著降低,AST、ALT、ASTm、CHE、AFU和GLDH的AUC分别为0.876、0.840、0.792、0.792、0.751和0.72,阳性率分别为100%、100%、93.6%、100%、72.3%和91.5%;原发性肝癌时NAG、AFU、LAP、ASTm、GLDH、ADA、AST、ALP、GGT和5'–NT均显著升高,CHE显著降低,AFU、5'–NT、GGT、ALP和LAP的AUC分别为0.822、0.814、0.811、0.795和0.713,阳性率分别为88.1%、85.7%、97.6%、95.2%和69.0%。结论:对急性肝炎诊断意义较大的指标为ALT、LAP、AFU、ASTm、AST和ALP;对肝硬化诊断意义较大的指标为ADA、AST、5'–NT、GGT和CHE;对重型肝炎诊断意义较大的指标为AST、ALT、ASTm、CHE、AFU和GLDH;对原发性肝癌诊断意义较大的指标为AFU、5'–NT、GGT、ALP和LAP;12项指标对慢性肝炎和酒精型肝炎的临床意义都较低。Objective To evaluate the diagnostic value of the examination of liver enzymology in patients suffering from liver diseases. Methods Serum values of NAG, AFU, LAP, ASTm, GLDH, ADA, AST, ALT, ALP, GGT, 5＇-NT and CHE were determined with auto-biochemical analyzer and analyzed statistically in 308 hepatitis patients and 115 healthy subjects. Results In acute hepatitis patients,the mean values of NAG, AFU, LAP, ASTm, GLDH, ADA, AST, ALT, ALP,GGT and 5＇ -NT increased significantly compared with those of healthy subjects, AUCs of ALT, LAP, AFU, ASTm,AST and ALP were 0.875, 0.861, 0.853, 0.830, 0.825 and 0.725 respectively, and positive rates of ALT, LAP, AFU, ASTm, AST and ALP were 100%, 93.8%, 78.1%, 87.5%, 100% and 68.8% respectively. In liver cirrhosis patients, the mean values of NAG, LAP, ASTm, GLDH, ADA, AST, ALP, GGT and 5＇-NT increased significantly while thatof CHE decreased significantly compared with those of healthy subjects, AUCs ofADA, AST, 5＇-NT, GGT and CHE were 0.764, 0.761, 0.752, 0.748 and 0.721 respectively, and positive ratesofADA, AST, 5＇-NT, GGT and CHE were 91.2%, 73.5%, 67.6%, 75.0% and 61.8% respectively. In severe hepatitis patients, the mean values of NAG, AFU, ASTm, GLDH, ADA, AST, ALT, ALP, GGT and 5＇-NT increased significantly while that of CHE decreased significantly compared with those of healthy subjects, AUCs of AST, ALT, ASTm, CHE, AFU and GLDH were 0.876, 0.840, 0.792, 0.792, 0.751 and 0.729 respectively, and positive rates ofAST, ALT, ASTm, CHE, AFU and GLDH were 100%, 100%, 93.6%, 100%, 72.3% and 91.5% respectively. In hepatocellular carcinoma, the mean values of NAG, AFU, LAP, ASTm, GLDH, ADA, AST, ALP, GGT and 5＇ -NT increased significantly while that of CHE decreased significantly compared with those of healthy subjects, AUCs ofAFU,5＇-NT, GGT, ALP and LAP were 0.822, 0.814, 0.811, 0.795 and 0.713 respectively, and positive rates ofAFU, 5＇-NT, GGT, ALP and LAP were 88.1%, 85.7%, 97.6%, 95.2% and 69.0% respectively. Conclusion ALT, LAP, AFU, ASTm, AST and ALP ar

关 键 词：肝病 肝酶学 肝功能 诊断 

分 类 号：R466.6[医药卫生—临床医学] R575