转氨酶水平在闭合性肝损伤患者中的意义  

Liver transaminase levels in patients with blunt abdominal trauma

作　　者：陈祝华 沈国 陈刚红 朱铁明 陈铁炯 

机构地区：[1]诸暨市人民医院普外科,311800

出　　处：《浙江医学》2014年第13期1153-1155,共3页Zhejiang Medical Journal

基　　金：2012绍兴市科技计划项目(2012d10013)

摘　　要：目的研究血清转氨酶水平在闭合性肝损伤患者中的表达及意义。方法回顾性研究163例闭合性腹部损伤患者的血清转氨酶水平(肝损伤79例,非肝损伤84例),观察其转氨酶水平与肝损伤的相关性。根据CT或者术中所见,将患者肝损伤进行分级,比较轻度肝损伤与重度肝损伤患者转氨酶水平的差异;根据治疗方法,分为保守治疗组和手术治疗组,比较两组患者转氨酶水平的差异。结果(1)闭合性肝损伤组患者入院时ALT水平为(358.21±77.48)U/L,AST水平为(416.32±88.00)U/L;非肝损伤组入院时ALT水平为(30.85±14.58)U/L,AST水平为(33.50±8.12)U/L,两组患者比较有统计学差异(均P=0.000)。ROC曲线显示诊断闭合性肝损伤时ALT阈值为.53.00U/L,AST阈值为67.50 U/L。(2)轻度肝损伤组患者(24例)入院时ALT水平为(189.33±57.71)U/L,AST水平为(251.00±69.35)U/L;重度肝损伤组(55例)入院时ALT水平为(431.91±104.46)U/L,AST水平为(488.47±120.18)U/L。两组比较均有统计学差异(P=0.004、0.014)。(3)保守治疗组患者(52例)ALT水平为(311.10±93.03)U/L,AST水平为(367.48±103.40)U/L;手术治疗组(27例)ALT水平为(448.96±140.45)U/L,AST水平为(510.41±166.46)U/L,手术治疗组患者转氨酶水平高于保守治疗组,但无统计学差异(P=0.098、0.132)。结论闭合性腹部损伤患者升高的转氨酶水平对于闭合性肝损伤的诊断有较高的价值,显著升高的ALT水平提示严重肝损伤的发生。Objective To investigate liver transaminase levels in patients with blunt abdominal trauma. Methods The clinical data of 163 patients with blunt abdominal injury admitted between January 2011 and January 2013 were retrospectively analyzed. The grading of the hepatic trauma was verified using CT scans or surgical findings. The patients were managed with surgical or non- surgical approaches. Results There were 79 patients with hepatic trauma and 84 patients without hepatic trau-ma. The levels of alanine aminotransferase （ALT） and aspartate aminotransferase （AST） in patients with hepatic trauma were sig-nificantly higher than those in patients without hepatic trauma [（358.21±77.48）U/L vs （930.85±14.58）U/L, P=0.000;and （416.32± 88.00）U/L vs （33.50±8.12）U/L, P=0.000]. In receiver operating characteristic （ROC） curve assessment, the optimum thresholds of ALT and AST in diagnosis of hepatic trauma were 53.00U/L and 67.50 U/L, respectively. The ALT and AST levels in patients with major hepatic trauma （gradesⅢ- Ⅵ, n=55） were significantly higher than those with minor hepatic trauma （grades I- Ⅱ, n=24） [（431.91±104.46）U/L vs （189.33±57.71）U/L, P=0.004 and （488.47±120.18）U/L vs （251.00±69.35）U/L, P=0.014]. There were no significant differences in ALT and AST levels between operation group and non- operation group [（448.96 ±140.45）U/L vs （311.10±93.03）U/L, P=0.098 and （510.41±166.46）U/L vs （367.48±103.40）U/L, P=0.132]. Conclusion The measurement of liver transaminase levels in patients with blunt abdominal trauma can differentiate patients with hepatic trauma from those without hep-atic trauma, and also differentiate major hepatic trauma from minor hepatic trauma.

关 键 词：转氨酶 闭合性肝损伤 闭合性腹部损伤 

分 类 号：R657.3[医药卫生—外科学]