肝脏酶谱对肝病类型及预后的临床诊断价值研究  

Clinical diagnostic value of liver enzymes for types of liver diseases and prognosis

作　　者：徐婷婷 胡蓉 康信通 曾义岚 罗东霞 李青峰 

机构地区：[1]成都市公共卫生临床医疗中心传染急诊,四川成都610061 [2]成都市公共卫生临床医疗中心肝病科,四川成都610061 [3]成都市公共卫生临床医疗中心院领导办公室,四川成都610061 [4]成都市公共卫生临床医疗中心科教科,四川成都610061 [5]成都市公共卫生临床医疗中心检验科,四川成都610061

出　　处：《中国现代医生》2017年第22期16-19,F0003,共5页China Modern Doctor

基　　金：四川省卫生和计划生育委员会科研课题(16PJ080)

摘　　要：目的 探讨肝脏酶谱对肝病类型及预后的临床诊断价值。方法选择2013年5月~2016年5月收治的肝病患者及健康体检者共计220例作为研究对象,其中急性乙肝患者43例、慢性乙肝患者51例,乙肝肝硬化患者49例、乙型肝炎病毒相关性肝细胞癌患者32例、健康体检者45例。对其资料进行回顾性分析,比较五组患者肝脏酶谱水平,包括丙氨酸转氨酶(alanine amino transferase,ALT)、天冬氨酸转氨酶(aspartate amino transferase,AST)、谷氨酰转肽酶(glutamyl transpeptadase,GGT)、碱性磷酸酶(alkaline phosphatase,ALP)、甲胎蛋白(α-fetoprotei,AFP),并使用受试者工作特征曲线(receiver operating characteristic curve,ROC)对检测结果进行评价。结果五组血清ALT、AST、GGT、ALP、AFP水平比较,差异有统计学意义(P<0.05)。其中急性乙肝组ALT、AST、GGT、ALP显著高于其余四组(P<0.05),肝硬化组与肝癌组ALT、AST、GGT显著高于慢性乙肝组(P<0.05),肝癌组AST、GGT、ALP、AFP水平显著高于肝硬化组(P<0.05)。当以血清肝脏酶谱联合预测急性乙肝时,ROC曲线下面积为0.992;预测慢性乙肝时,ROC曲线下面积为0.920;预测肝硬化时,ROC曲线下面积为0.659;预测肝癌时,ROC曲线下面积为0.627。采用COX比例风险回归模型分析肝脏酶谱与肝癌患者生存时间的关系,结果显示ALP水平是影响肝癌患者生存时间的预后相关因素。结论通过检测肝脏酶谱水平有助于对不同类型肝脏疾病进行鉴别诊断,且ALP可以用于肝癌患者预后的评估。Objective To investigate the clinical diagnostic value of liver enzymes for types of liver diseases and prog- nosis. Methods A total of 220 cases patients with liver disease and physical examination from May 2013 to May 2016 were selected as the research objects, among whom there were 43 cases of acute hepatitis B, 51 cases of chronic hep- atitis B, 49 cases of hepatitis B cirrhosis, 32 cases of hepatitis B virus related hepatocellular carcinoma, and 45 cases of physical examination. The liver zymogram levels were compared among the five groups and the results were evaluated by ROC curve. Results The levels of serum ALT, AST, GGT, ALP and AFP in the five groups were statistically signifi- cant（P〈0.05）. Among which the levels of ALT, AST, GGT and ALP in the acute hepatitis B group were significantly higher than those in the other four groups （/〉〈0.05）, the levels of ALT, AST and GGT in cirrhosis group and HCC group were significantly higher than those in chronic hepatitis B group （P〈0.05） and the levels of AST, GGT, ALP and AFP in HCC group were significantly higher than those in cirrhosis group（P〈0.05）. When serum liver enzymes were com- bined to predict acute hepatitis B, chronic hepatitis B, liver cirrhosis and liver cancer, the areas under the ROC curve were respectively 0.992, 0.920, 0.659 and 0.627. When the COX proportional hazards regression model was used to an- alyze the relationship between liver enzymes and the survival time of HCC patients, the results showed that the level of ALP was a prognostic factor in the survival time of HCC patients. Conclusion The detection of liver zymogram levels is helpful for differential diagnosis of different types of liver diseases, and ALP can be used for prognostic evaluation of HCC patients.

关 键 词：肝脏疾病 肝脏酶谱ROC曲线 诊断 预后 

分 类 号：R446.1[医药卫生—诊断学]