肝功能指标对胆囊结石继发无症状胆总管结石的预判价值  

Value of liver function test for prediction of asymptomatic common bile duct stones in patients with cholecystolithiasis

作　　者：徐晓平[1] 许健波[1] 胡俊青[1] 

机构地区：[1]金华市中心医院检验科,浙江省金华市321300

出　　处：《世界华人消化杂志》2016年第31期4293-4298,共6页World Chinese Journal of Digestology

摘　　要：目的探讨血清肝功能指标异常对胆囊结石合并无症状胆总管结石的预判价值.方法回顾性分析金华市中心医院2012-01/2016-01收治的398例胆囊结石患者的临床资料.根据是否合并无症状胆总管结石,分为胆囊结石合并无症状胆总管结石组(简称胆总管结石组)和单纯胆囊结石组(简称胆囊结石组),比较两组患者的肝功能指标情况,评估肝功能指标异常对无症状胆总管结石的预判价值.结果胆总管结石组与胆囊结石组血清谷丙转氨酶、谷草转氨酶、总胆红素及直接胆红素的比较,差异无统计学意义(P>0.05).胆总管结石组和胆囊结石组血清?-谷氨酰转肽酶(gamma-glutamyl transpeptidase,GGT)分别为(150.89 U/L±40.95 U/L vs 36.58 U/L±11.28 U/L),碱性磷酸酶(alkaline phosphatase,A L P)分别为(142.83 U/L±21.99 U/L v s120.96 U/L±20.27 U/L),差异有统计学意义(P<0.05).ROC曲线分析显示血清GGT、A L P对应曲线下面积分别为0.914、0.569,诊断准确度最高的临界值分别为89.5 U/L、136 U/L,敏感度分别为89.9%、45.8%,特异度分别为91.8%、71.9%.结论血清GGT的异常升高对胆囊结石合并无症状胆总管结石有较大的预判价值.AIM Toinvestigate the diagnostic value of abnormal liver function parameters for concomitant asymptomatic choledocholithiasis in cholecystolithiasis patients. METHODS The clinical data of 398 patients with cholecystolithiasis treated at our hospital from January 2012 to January 2016 were retrospectively analyzed.According to the presence of concomitant asymptomatic choledocholithiasis or not the patients were divided into two groups：choledocholithiasis group and cholecystolithiasis group. The risk factors for the disease were evaluated. The receiver operating characteristic（ROC） curves for the significant parameters were generated to assess their sensitivities and specificities for diagnosis of concomitant asymptomatic choledocholithiasis in cholecystolithiasis patients. RESULTS There were no significant differences in serum levels of alanine transaminase（ALT） aspartate transaminase（AST） total bilirubin（TBIL） or indirect bilirubin（DBIL） between the choledocholithiasis and cholecystolithiasis groups. Serum levels of g-glutamyltransferase（GGT） and alkaline phosphatase（ALP） in the choledocholithiasis group were significantly higher than those in the cholecystolithiasis group（P〈0.05）. The ROC curve analysis showed that the areas under the ROC curve of GGT and ALP were 0.914 and 0.569 and the corresponding cut-off values were 89.5 U/L and 136 U/L（sensitivity： 89.9% and 45.8%; specifi city： 79.18% and 71.90%） respectively. CONCLUSION Abnormally elevated GGT and ALP have value for prediction of concomitant asymptomatic choledocholithiasis in cholecystolithiasis patients.

关 键 词：胆囊结石 胆总管结石 肝功能 Γ-谷氨酰基转移酶 诊断 

分 类 号：R657.42[医药卫生—外科学]