ADA、ALP、GGT血清水平对肝细胞性黄疸与梗阻性黄疸的诊断效能  

Combined Detection of ADA,ATP and GGT in the Diagnosis of Hepartocellular and Obstructive Jaundice

作　　者：谢军 褚玲 程德芹 石冬敏[2] 

机构地区：[1]江苏省盱眙县人民医院,淮安211700 [2]南京医科大学附属苏州市立医院,苏州215002

出　　处：《微循环学杂志》2016年第4期38-41,共4页Chinese Journal of Microcirculation

摘　　要：目的:回顾性分析腺苷脱氨酶(ADA)、碱性磷酸酶(ALP)、谷氨酰转移酶(GGT)联合检测对肝细胞性黄疸与梗阻性黄疸的诊断效能。方法:临床确诊为肝细胞性黄疸患者90例(肝黄组)、梗阻性黄疸患者72例(梗黄组),另选体检健康人群87例作为正常对照(对照组)。采用全自动生化仪(速率法)检测分析各组血清ADA、ALP和GGT水平差异,并采用ROC曲线评价ADA、ALP、GGT单检或联检对肝细胞性黄疸和梗阻性黄疸的诊断效能。结果:肝黄组、梗黄组和对照组ADA分别为30.62±12.44U/L、15.81±4.92U/L、11.85±3.93U/L;ALP分别为219.67±98.49U/L、404.29±205.52U/L、81.78±18.19U/L;GGT分别为248.89±160.11U/L、467.26±334.00U/L、20.10±11.05U/L;组间各指标水平差异均有统计学意义(P<0.01);ADA、ALP、GGT诊断肝细胞性黄疸的cut off值分别为>16.0U/L、>120.0U/L、>50.0U/L,ROC曲线下面积(AUC)分别为0.96、0.99、0.99,敏感度分别为0.91、0.96、0.97,特异度分别为0.88、0.98、1.00;诊断梗阻性黄疸的cut off值分别为>12.1U/L、>120.0U/L、>50.0U/L,AUC分别为0.77、0.97、0.99,敏感度分别为0.78、0.96、0.98,特异度分别为0.69、0.98、1.00。三指标联合检测诊断肝细胞性黄疸的敏感度为1.00,特异度为0.69,阳性预测值为0.78,阴性预测值为1.00,约登指数(YI)为0.69;诊断梗阻性黄疸的灵敏度为1.00,特异度为0.69,阳性预测值为0.73,阴性预测值为1.00,YI为0.69。结论:ALP、GGT单检对肝细胞性和梗阻性黄疸的敏感度和特异度均较高,尤其GGT对两者的特异度更高;ADA单检对梗阻性黄疸的敏感度和特异度均较低。三指标联检可提高诊断敏感度和筛选准确率。Objective：To analyze the joint detection among adenosine deaminase（ADA）,alkaline phosphatase（ALP）,glutamyl transferase（GGT）in the diagnostic efficacy of hepatocellular jaundice and obstructive jaundice.Method：90patients with hepatocellular jaundice（hepatocellular group）and 72 patients with obstructive jaundice（peduncle group）were clinically proved.87 healthy people were chosen as normal control group in medical examination（control group）.Automatic biochemical analyzer and rate method were used to analyze the levels of serum ADA,ALP and GGT,and ROC curve was used to evaluate the diagnostic efficiency of single or joint detection of ADA,ALP,GGT for hepatocellular jaundice and obstructive jaundice.Results：The ADA of hepatocellular group,peduncle group and control group were 30.62±12.44U/L,15.81±4.92U/L and 11.85±3.93U/L respectively;ALP were 219.67±98.49U/L,404.29±205.52U/L and 81.78±18.19U/L respectively;GGT was respectively 248.89±160.11U/L,467.26±334.00U/L and 20.10±11.05U/L;There was statistical significance for each index level difference among the groups（P〈0.01）.The cut off of hepatocellular jaundice diagnosed by ADA,ALP and GGT were16.0U/L,120.0U/L,50.0U/L,the areas under the ROC curve（AUC）were 0.96,0.99 and 0.99 respectively.The cut off of peduncle jaundice diagnosed by ADA,ALP and GGT were12.1U/L,120.0U/L and50.0U/L respectively.The AUC of obstructive jaundice was 0.77,0.97and0.99 respectively.The sensitivities of being diagnosed to be hepatocellular jaundice were 0.91,0.96 and 0.97 respectively,and the specificities were 0.88,0.98 and 1.00 respectively.The sensitivities of being diagnosed to be obstructive jaundice were 0.78,0.96 and 0.98 respectively,and the specificities were 0.69,0.98 and 1.00 respectively.The sensitivity of hepatocellular jaundice under joint detection of three indexes was 1.00,the specificity was 0.69,the positive predictive value was 0.78,the negative predictive value was 1.00 and YD index（YI）was 0.69;the sensitivity of obstructive

关 键 词：腺苷脱氨酶 碱性磷酸酶 谷氨酰转移酶 黄疸 

分 类 号：R575[医药卫生—消化系统]