肝功能指标在诊断胆囊结石合并无症状胆总管结石中的作用  

The role of liver function test in diagnosing concomitant asymptomatic common bile duct stone in patients with cholecystolithiasis

作　　者：李永杰[1] 周耿[1] 方孟园 刘莉[1] 

机构地区：[1]遵义医学院附属医院肝胆外科,贵州563000

出　　处：《中华肝胆外科杂志》2014年第6期431-434,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨肝功能指标对胆囊结石合并无症状胆总管结石的诊断意义。方法收集2012年1月至2013年10月遵义医学院附属医院胆石症患者426例。按照是否有肝功能异常将患者分成胆总管结石组（n=44）和单纯胆囊结石组（n=382），分析比较各项肝功能指标（ALT、AST、AKP、GGT、TBil、DBil）对胆总管结石的诊断意义。结果426例胆囊结石患者中，男159例，女231例，平均（50．96±12．93）岁。合并胆总管结石44例，肝功能异常发生率77．27％（34／44）；单纯胆囊结石组382例，肝功能异常发生率4．45％（17／382），胆总管结石组患者的肝功能异常发生率高于单纯胆囊结石组（X^2=198．54；P=0．000）。分析显示肝功能各项指标升高与胆总管结石有关（均P〈0．05）。多因素逐步回归分析：Y=-0．911＋1．142ALT＋0．818AST-0．488AKP＋2．310GGT-0．065TBil-0．544DBil。其中，GGT具有明显的诊断价值（OR=10．067，P=0．007）；ROC曲线分析显示，GGT的ROC曲线下面积为0．881；取诊断值为84．5U／L，其灵敏度为72．2％，特异性为96．1％，阳性预测值为76．3％，阴性预测值为96．2％。结论实验表明，肝功能尤其GGT，可作为胆囊结石术前判断患者是否合并无症状胆总管结石的重要预测指标。Objective To determine the role of liver function test in the preoperative diagnosis of concomitant asymptomatie common bile duct （CBD）stone in patients with cholecystolithiasis. Methods A retrospective study was conducted from January 2012 to October 2013 at the Department of Hepatobiliary Surgery, the Affiliated Hospital of Zunyi Medical College on 426 patients who were operated for cholecystolithiasis. According to whether they had abnormal liver function, these patients were divided into the CBD stone group （n = 44） and the cholecystolithiasis group （n = 382）. The values of the different components of liver functions test such as ALT, AST, AKP, GGT, TBIL and DBIL in diagnosing CBD stone were statistically analyzed. Results This study involved 426 patients, 159 men and 231 women, with a mean age of （50.96 ± 12.93 ） years. 44 patients with both CBD stone and cholecystolithiasis. The rates of abnormal liver function were 77.27% （34/44） vs 4.45% （17/382） in CBD stone group vs eholecystolithiasis group. The difference was significant （ X^2 = 198.54 ; P = 0. 000 ）. In logistic regression analysis, only elevated serum level of GGT （ OR = 10. 067 ; P = 0. 007 ） remained as an independent predictor of CBD stone. On ROC （ re- ceiver operating characteristic） curves analysis, the area under the curve was 0. 881. With a cut-off point for GGT at 84. 5 U/L, there was a sensitivity of 72. 2 per cent, specificity of 96. 1 per cent, and positive and negative predictive values of 76. 3 per cent and 96. 2 per cent respectively. Conclusion Our study showed that liver function, especially GGT, was a predictor of CBD stone.

关 键 词：肝功能指标 胆总管结石 胆囊结石 

分 类 号：R657.4[医药卫生—外科学]