血清碱性磷酸酶、谷氨酰转肽酶及其倍值比在胆汁淤积性肝病中的鉴别价值

发布时间：2018-06-23 23:29

本文选题：胆汁淤积性肝病 + 碱性磷酸酶　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:探讨血清碱性磷酸酶(alkaline phosphatase,ALP)、γ-谷氨酰转肽酶(γ-glutamyl transpeptidase,GGT)及其倍值比(ALP实测值/ALP ULN)/(GGT实测值/GGT ULN)在药物性胆汁淤积性肝损伤、原发性胆汁性胆管炎(primary biliary cholangitis,PBC)、胆总管结石这3种胆汁淤积性肝病中的鉴别价值(倍值比简称ALP~×/GGT~×,ULN为正常范围上限)。方法:根据纳入标准和排除标准,收集来自山西医科大学第二医院2012年01月至2016年07月住院患者的病例,分别设为药物性胆汁淤积肝损伤组、PBC组、胆总管结石组、对照组,前3组为病例组。采用速率法检测血清ALP、GGT水平。绘制ALP、GGT和ALP~×/GGT~×的受试者工作特征曲线(简称ROC曲线),分析其鉴别药物性胆汁淤积性肝损伤、PBC、胆总管结石的效能。结果:1.基本资料分析对照组与病例组的年龄、性别无显著地统计学差异(P0.05)。2.各组间血清ALP水平的比较对照组血清ALP水平明显低于3病例组(P0.05)。3病例组间血清ALP无显著性统计学差异(P0.05)。3.各组间血清GGT水平的比较对照组血清GGT水平明显低于3病例组,差异有统计学意义(P0.05)。3病例组间血清GGT水平有统计学差异(P0.05);药物性胆汁淤积组的血清GGT水平[(152.2±51.0)U/L]与PBC组[(230.5±121.0)U/L]的无显著性差异(P0.05);胆总管结石组血清GGT水平[(424.7±317.0)U/L]分别高于药物性胆汁淤积组[(152.2±51.0)U/L]和PBC组[(230.5±121.0)U/L],组间的两两比较差异有统计学意义(P0.05)。4.3病例组间ALP与GGT的倍值比即ALP~×/GGT~×的比较3病例组间ALP~×/GGT~×水平比较有显著差异(P0.05);药物性淤胆组的倍值比(0.95±0.54)大于PBC组(0.64±0.33)和胆总管结石组(0.37±0.18);PBC组的倍值比(0.64±0.33)大于胆总管结石组(0.37±0.18);组间的两两比较均有统计学意义(P0.05)。5.ALP、GGT和ALP~×/GGT~×的ROC曲线ALP、GGT和ALP~×/GGT~×鉴别药物性胆汁淤积(阳性组,表示为+)与PBC(阴性组,表示为-)的ROC曲线下面积分别为0.645、0.319和0.741,鉴别PBC(+)与胆总管结石性胆汁淤积(-)ROC曲线下面积分别为0.498、0.298和0.749,鉴别药物性胆汁淤积(+)与胆总管结石性胆汁淤积(-)ROC曲线下面积分别为0.552、0.189和0.972;可以看出ALP~×/GGT~×的曲线下面积最大。6.ALP~×/GGT~×的灵敏度、特异度及临界值(cut-off值)ALP~×/GGT~×鉴别药物性胆汁淤积与PBC的灵敏度和特异度为90.9%和62%,鉴别PBC与胆总管结石的灵敏度和特异度为100%和38.5%,鉴别药物性胆汁淤积与胆总管结石的灵敏度和特异度为100%和84.6%;相对应的cut-off值分别为0.599、0.225、0.534。结论:1.ALP、GGT单一指标不能鉴别胆汁淤积性肝病。2.ALP~×/GGT~×用于鉴别药物性胆汁淤积与PBC、药物性胆汁淤积与胆结石、PBC与胆总管结石的cut-off值分别是0.599、0.534和0.225。
[Abstract]:Objective: to investigate the effects of serum alkaline phosphatase (ALP), 纬 -glutamyl transpeptidase (纬 -glutamyl transpeptidase) (GGT) and its ratio of ALP / GGT on drug-induced cholestatic liver injury. The differential value of (primary biliary cholangitis and choledocholithiasis in cholestatic liver disease (ALP ~ 脳 / GGT ~ 脳 ULN is the upper limit of normal range). Methods: according to the inclusion criteria and exclusion criteria, the patients admitted from the second Hospital of Shanxi Medical University from January 2012 to July 2016 were divided into three groups: PBC group, choledocholithiasis group and control group. The first three groups were case group. The level of serum ALP GGT was detected by rate method. The operating characteristic curves (ROC curves) of ALPGGT and ALPX / GGT ~ 脳 were drawn to analyze the ability of differentiating PBC and choledocholithiasis in patients with drug-induced cholestatic liver injury. The result is 1: 1. Basic data analysis between the control group and the case group of age, gender, there was no significant statistical difference (P0.05). 2. The level of serum ALP in the control group was significantly lower than that in the 3 cases group (P0.05). There was no significant difference in serum ALP between the three groups (P0.05). 3. Comparison of serum GGT levels among groups the serum GGT levels in the control group were significantly lower than those in the 3 cases group. The serum GGT level in drug induced cholestasis group [(152.2 卤51.0) U / L] was not significantly different from that in PBC group [(230.5 卤121.0) U / L] (P0.05); the serum GGT level in choledocholithiasis group [(424.7 卤317.0) U / L] was higher than that in drug group (P 0.05). Sexual cholestasis group [(152.2 卤51.0) U / L] and PBC group [(230.5 卤121.0) U / L], there was significant difference between the two groups (P0.05) .4.3 the double ratio of ALP and GGT between the two groups was significant difference (P0.05); the double value ratio of ALP and GGT was (0.95 卤0.54) between the three groups (P0.05); the drug cholestasis group (0.95 卤0.54). Compared with PBC group (0.64 卤0.33) and choledocholithiasis group (0.37 卤0.18), the doubling ratio of PBC group (0.64 卤0.33) was greater than that of common bile duct stone group (0.37 卤0.18), and the comparison between two groups had statistical significance (P0.05). And PBC (negative group, The areas under the ROC curve were 0.645U 0.319 and 0.741.The areas under the ROC curve for distinguishing PBC () from choledocholithiasis (-) were 0.4980.298 and 0.749, respectively. The difference between drug-induced cholestasis () and cholestasis of the common bile duct (-) under the ROC curve was 0.4980.298 and 0.749, respectively. The area is 0.552 ~ 0.189 and 0.972 respectively. It can be seen that the area under the curve of ALP ~ 脳 / GGT ~ 脳 is the largest. 6. The sensitivity of ALP ~ 脳 / GGT ~ 脳, The sensitivity and specificity of ALP ~ 脳 / GGT ~ 脳 in differentiating drug cholestasis from common bile duct stones were 90.9% and 62%, respectively. The sensitivity and specificity of ALP ~ 脳 / GGT ~ 脳 were 100% and 38.5% for differentiating cholestasis from choledocholithiasis, and for differentiating choledocholithiasis from choledocholithiasis. The sensitivity and specificity were 100% and 84.6%, respectively, and the corresponding cut-off values were 0.599,0.225 and 0.534, respectively. Conclusion: 1. The single index of ALPGGT can not distinguish cholestatic liver disease. 2. ALPX 脳 / GGTX is used to distinguish drug cholestasis from PBC.The cut-off values of drug cholestasis and cholelithiasis are 0.534 and 0.225, respectively.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575

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