药物性胆汁淤积肝胆生化指标的对比研究及ROC曲线分析  

ROC curve analysis and comparative study of hepatobiliary biochemical indexes of drug-induced cholestasis

作　　者：任晶晶 张丽香 韩子岩 REN Jing-Jing;ZHANG Li-xiang;HAN Zi-yan(Department of Gastroenterology,the Second Hospital of Shanxi Medical University)

机构地区：[1]山西医科大学第二临床医学院消化内科,太原030000

出　　处：《肝脏》2021年第9期968-971,983,共5页Chinese Hepatology

摘　　要：目的探讨并对比研究药物性胆汁淤积的肝胆生化指标的特征及诊断价值。方法收集2012年1月至2019年7月因药物性肝损伤(DILI)、胆总管结石(CBDS)或原发性胆汁性胆管炎(PBC)相关性胆汁淤积入住于山西医科大学第二医院的病例,共135例,分为3组,记录每组肝胆生化指标TBA、TBil、5′-NT、γ-GT、ALP、ALT和AST。运用SPSS软件,进行正态性检验、单因素方差分析、秩和检验、卡方检验和ROC曲线分析。结果DILI组TBA水平显著高于PBC组和CBDS组(P>0.05)。DILI组TBil水平显著高于PBC组(P<0.05),与CBDS组差异无统计学意义(P>0.05)。DILI组γ-GT水平显著低于CBDS和PBC组(P<0.05)。DILI组5′-NT水平显著低于CBDS组(P<0.05),与PBC组差异无统计学意义(P>0.05)。DILI组ALP水平与PBC和CBDS组间差异无统计学意义(P>0.05)。DILI组ROC曲线分析显示血清TBA的曲线下面积为0.990,P=0.000,Cut-Off值为120.2μmol/L,灵敏度97.4%,特异度100%。DILI组血清ALP与γ-GT倍值比的ROC曲线下面积为0.930,P=0.000,Cut-Off值为0.74(1∶1.35),灵敏度89.5%,特异度89.5%。DILI组血清TBil的ROC曲线下面积为0.751,P=0.000,Cut-Off值为171.62μmol/L,灵敏度100%,特异度55.8%。DILI组血清ALP、5′-NT和γ-GT水平的ROC曲线分析无意义。结论药物性胆汁淤积的TBA水平显著高于其他胆汁淤积,以及γ-GT水平显著低于其他胆汁淤积极有可能是其标志性表现,其次,5′-NT水平显著低于CBDS相关性胆汁淤积,与PBC相似,ALP水平在常见胆汁淤积病种间无差异。TBA水平和ALP与γ-GT的倍值比的Cut-Off值对药物性胆汁淤积的诊断有极高准确性,灵敏度和特异度极佳。Objective To investigate the characteristics and diagnostic value of hepatobiliary biochemical indexes of drug-induced cholestasis.Methods A total of 135 inpatients with drug-induced liver injury(DILI),bile duct stones(CBDS)or primary biliary cholangitis(PBC)admitted to our hospital from January 2012 to July were included.They were randomly divided into 3 groups..A series of assay indexes were recorded,including total bile acid(TBA),total bilirubin(TBil),gamma-glutamyltransferase(GGT),alkaline phosphatase(ALP),5-nucleotidase(5′-NT),alanine aminotransferase(ALT)and aspartate aminotransferase(AST).Normality test,one-way analysis of variance,rank sum test,chi-square test and receiver operating characteristic(ROC)curve analysis were performed through SPSS software.Results TBA level of DILI group was significantly higher than those of PBC and CBDS group(P<0.05).TBil level of DILI group was significantly higher than that of PBC group(P<0.05).However,there was no statistical difference of TBil level between DILI group and CBDS group(P>0.05).GGT level of DILI group was significantly lower than those of CBDS and PBC group(P<0.05).The 5′-NT level of DILI group was significantly lower than that of CBDS group(P<0.05).However,there was no statistical difference of 5′-NT level between DILI and PBC group(P>0.05).There was no statistical difference in ALP level among three groups(P>0.05).The ROC curve of the DILI group showed that the area under the curve(AUC)of TBA level was 0.990,P=0.000,the cut-off value was 120.2μmol/L,and its sensitivity and specificity were 97.4%and 100%,respectively.The AUC of ALP:GGT ratio of DILI group was 0.930,P=0.000,the cut-off value was 0.74(1∶1.35),its sensitivity and specificity were 89.5%and 89.5%,respectively.The AUC of TBil level in DILI group was 0.751,P=0.000,its cut-off value was 171.62μmol/L,its sensitivity and specificity were 100%and 55.8%,respectively.There was no significant difference in ROC curve analysis of ALP,5′-NT and GGT levels of the DILI group.Conclusion Among diff

关 键 词：药物性胆汁淤积 总胆汁酸 5’-核苷酸酶 碱性磷酸酶 Γ-谷氨酰转肽酶 总胆红素 对比研究 ROC曲线分析 

分 类 号：R57[医药卫生—消化系统]