γ-谷氨酰转移酶对胆总管结石的预判价值

发布时间：2018-11-03 19:59

【摘要】：目的探讨γ-谷氨酰转肽酶(γ-glutamyltransferase,GGT)异常对胆总管结石的诊断价值。方法回顾分析2016年1月至2016年12月行腹腔镜联合胆道镜行胆总管探查术的248例患者的临床资料,以胆道镜发现胆总管结石为金标准,评价患者术前GGT对胆总管结石诊断的灵敏度和特异度,构建受试者工作特征(receiver operating characteristic,ROC)曲线。结果术前检测GGT对胆总管结石的诊断情况如下:ROC曲线下面积为0.729,最佳诊断点的临界值为93.5 U/L,对应的灵敏度和特异度分别为78.47%和56.73%,阳性预测值和阴性预测值为21.34%~24.25%和93.72~95.95%,准确率为69.35%;去除泥沙样结石后:ROC曲线下面积为0.779,计算所对应最佳诊断点的临界值为93.5 U/L,对应的灵敏度和特异度分别为74.36%和74.04%,阳性预测值和阴性预测值为24.14%~33.58%和94.24%~96.29%,准确率为74.2%。结论 GGT为胆总管结石诊断的灵敏度指标,但对于泥沙样结石的特异度不高。当GGT93.5 U/L时,应高度怀疑胆总管结石,应进一步行磁共振胰胆管造影(magnetic resonance cholangiopancreatography,MRCP)或内镜逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)检查,并可作为胆总管探查的指征之一。
[Abstract]:Objective to investigate the diagnostic value of 纬-glutamyl transpeptidase (纬-glutamyltransferase,GGT) in choledocholithiasis. Methods from January 2016 to December 2016, the clinical data of 248 patients with choledocholithiasis by laparoscopy combined with choledochoscope were retrospectively analyzed. To evaluate the sensitivity and specificity of GGT in the diagnosis of choledocholithiasis before operation, and to construct the (receiver operating characteristic,ROC curve. Results the diagnosis of choledocholithiasis by GGT before operation was as follows: the area under the ROC curve was 0.729, the critical value of the best diagnostic point was 93.5 U / L, the sensitivity and specificity were 78.47% and 56.73%, respectively. The positive predictive value and negative predictive value were 21.34% and 93.72% respectively, and the accuracy rate was 69.35%. After removing silt stone, the area under ROC curve was 0.779, the critical value of calculating the best diagnostic point was 93.5 U / L, the sensitivity and specificity were 74.36% and 74.04%, respectively. The positive predictive value and negative predictive value were 33.58% and 94.24246.29%, and the accuracy rate was 74.22.The positive predictive value and the negative predictive value were 24.14% and 94.24% respectively. Conclusion GGT is a sensitive index for the diagnosis of choledocholithiasis, but its specificity is not high. When GGT93.5 U / L, choledocholithiasis should be highly suspected, Mr cholangiopancreatography (magnetic resonance cholangiopancreatography,MRCP) or endoscopic retrograde cholangiopancreatography (endoscopic retrograde cholangiopancreatography,ERCP) should be performed, and it can be used as one of the indications of choledochus exploration.
【作者单位】：北京市隆福医院普外科;首都医科大学附属北京友谊医院普外科;
【基金】：首都临床特色应用研究(Z161100000516082) 北京市属医院科研培育计划项目(PX2016001) 首都卫生发展科研专项重点攻关项目(2016-1-1111)~~
【分类号】：R657.42

【相似文献】