血清生化标志物结合APRI对实验室诊断肝脏疾病的临床应用价值  

The Clinical Application Value of Serum Biochemical Markers Combined with APRI in Laboratory Diagnosis for Liver Diseases

作　　者：张鹏 朱进华[2] 杨彬[2] 汪峰 ZHANG Peng;ZHU Jinhua;YANG Bin;WANG Feng(Department of Clinical Laboratory,Yangzhong People’s Hospital,Jiangsu Province,Yangzhong 212200,China;Yangzhong People’s Hospital,Jiangsu Province,Yangzhong 212200,China)

机构地区：[1]江苏省扬中市人民医院检验科,江苏扬中212200 [2]江苏省扬中市人民医院,江苏扬中212200

出　　处：《标记免疫分析与临床》2024年第7期1287-1291,共5页Labeled Immunoassays and Clinical Medicine

基　　金：镇江市社会发展指导性科技计划项目(编号:FZ2022032)。

摘　　要：目的探讨血清甘胆酸(glycocholic acid,CG)、总胆汁酸(total bile acid,TBA)等生化指标联合天冬氨酸转氨酶(AST)/血小板(PLT)比率指数(APRI)对肝脏疾病的诊断价值。方法选取90例肝病患者,按临床诊断分成病毒性肝炎(36例)、肝硬化(36例)和肝癌(18例)3个亚组,另选取同期进行健康体检人员45例作为健康对照组。测定CG、TBA等各项生化指标并通过公式计算相应指数,经统计学分析单个生化指标以及将各生化指标进行不同组合后,分别分析其与肝脏疾病的相关性,探究其在诊断肝脏疾病中的应用价值。结果除病毒性肝炎组的FIB-4外,肝病组中其余指标均显著高于健康对照组(P<0.05)。除血清ALT指标外,肝硬化和肝癌组各指标均高于病毒性肝炎组(P<0.05);受试者工作曲线分析显示,TBA曲线下面积最大,且灵敏性最高;CG的特异性最高;APRI相关指标数据优于丙氨酸氨基转移酶(ALT)等传统肝功能指标;联合CG、TBA、APRI 3个指标进行肝脏疾病诊断时,其阳性检出率最高。结论在肝脏疾病的诊断中,血清TBA和CG的诊断效能较高,并且与APRI 3者联合应用在提示肝脏不同疾病时具有一定的临床价值。Objective To investigate the diagnostic value of serum glycocholic acid(CG),total bile acid(TBA)and L-Aspartic Acid aminotransferase platelet ratio index(APRI)in liver diseases.Methods 90 patients with liver diseases were divided into three subgroups according to clinical diagnosis results:hepatitis liver disease(n=36),liver cirrhosis(n=36)and hepatocellular carcinoma(n=18).In addition,45 healthy physical examination subjects were selected as a healthy control group.The biochemical tests,including CG,TBA and several others were measured and the corresponding indexes were calculated through formulas.Through statistical analysis of single biochemical tests and different combinations of biochemical tests,the correlations between each biochemical test results and liver diseases were analyzed respectively,so as to explore its application value in the diagnosis of liver diseases.Results The indicators in the liver disease group,except FIB-4 of the viral hepatitis group,were all significantly higher than those in the healthy control group(P<0.05).Except the serum ALT,all indicators in the cirrhosis and liver cancer groups were higher than those in the viral hepatitis group(P<0.05).Receiver operating curve analysis showed that TBA had the largest area under the curve and the highest sensitivity,and CG had the highest specificity.The APRI data were better than the traditional liver function indexes such as ALT.We also obtained the highest diagnosis positive rate when combining CG,TBA and APRI in the laboratory biochemical tests of liver diseases.Conclusion Serum TBA and CG are more effective in the diagnosis of liver diseases,and the combination of TBA and CG with APRI has a promising clinical value in the diagnosis of different liver diseases.

关 键 词：甘胆酸 总胆汁酸 APRI 肝脏疾病 相关性 

分 类 号：R446[医药卫生—诊断学]