摘要
目的 研究生化检验中肝功能指标检测对肝硬化患者的诊断价值.方法 将 2020 年 7 月—2022 年 7 月在平邑县人民医院就诊的 300 例肝硬化患者纳入肝硬化组,将 200 例慢性乙型病毒性肝炎(乙肝)患者纳入乙肝组,将同期在该院进行体检的 300 例健康体检者纳入健康对照组.再根据Child-Pugh分级将肝硬化组患者分为A级组(149 例)、B级组(97 例)、C级组(54 例).应用全自动生化分析仪检测天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、碱性磷酸酶(ALP)、胆碱酯酶(CHE),采用比色法检测白蛋白(ALB)、总蛋白(TP)、总胆红素(TBil),比较各组上述指标水平.结果 肝硬化组的AST、ALT、ALP、TBil水平均明显高于乙肝组和健康对照组,CHE、ALB、TP水平均明显低于乙肝组和健康对照组[AST(U/L):58.64±8.13 比 45.36±6.08、20.35±2.17;ALT(U/L):65.20±5.24 比 54.29±4.83、15.46±2.05;ALP(U/L):189.50±10.51 比 171.35±7.44、72.65±5.56;TBil(μmol/L):94.55±9.11 比 84.56±7.36、10.95±1.42;CHE(U/L):2119.43±76.80比3245.52±197.26、7125.65±228.95;ALB(g/L):19.26±1.82比27.91±2.65、42.54±4.28;TP(g/L):38.29±2.10 比 51.42±2.84、73.72±4.31;均P<0.05].肝硬化组中,Child-Pugh C级患者的AST、ALT、ALP、TBil水平均明显高于B级和A级患者,CHE、ALB、TP水平均明显低于B级和A级患者[AST(U/L):72.04±9.15 比 55.16±7.92、48.72±7.35;ALT(U/L):75.77±5.77 比 62.54±5.13、57.29±4.82;ALP(U/L):201.56±11.72 比 188.69±10.06、178.25±9.75;TBil(μmol/L):149.20±10.56 比 74.59±8.95、59.86±7.82;CHE(U/L):1342.72±65.28 比 1879.54±79.14、3136.03±85.98;ALB(g/L):17.29±1.22 比18.47±1.59、22.02±2.65;TP(g/L):33.54±1.31 比 37.77±2.20、43.56±2.79;均P<0.05].肝功能指标联合检测诊断肝硬化的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为 96.33%、99.00%、97.40%、99.31%、94.74%.结论 生化检验中多项肝功能相关指标联合检测对肝硬化进行诊断的价值较高,且能够与慢性乙肝进行鉴别区分.
Abstract
Objective To investigate the diagnostic value of liver function indexes detection in biochemical tests for patients with liver cirrhosis.Methods The 300 patients with liver cirrhosis who received medical treatment in Pingyi County People's Hospital from July 2020 to July 2022 were included in cirrhosis group,200 patients with chronic hepatitis B were included in hepatitis B group,and 300 healthy examiners who underwent physical examination in the hospital during the same period were included in healthy control group.According to Child-Pugh classification,the patients in cirrhosis group were divided into grade A group(149 cases),grade B group(97 cases)and grade C group(54 cases),respectively.The levels of aspartate aminotransferase(AST),alanine aminotransferase(ALT),alkaline phosphatase(ALP)and cholinesterase(CHE)were determined by automatic biochemical analyzer,and the levels of albumin(ALB),total protein(TP)and total bilirubin(TBil)were determined by colorimetry.The levels of above indicators in each group were compared.Results The levels of AST,ALT,ALP and TBil in cirrhosis group were higher than those in hepatitis B group and healthy control group,and the levels of CHE,ALB and TP in cirrhosis group were lower than those in hepatitis B group and healthy control group[AST(U/L):58.64±8.13 vs.45.36±6.08,20.35±2.17;ALT(U/L):65.20±5.24 vs.54.29±4.83,15.46±2.05;ALP(U/L):189.50±10.51 vs.171.35±7.44,72.65±5.56;TBil(μmol/L):94.55±9.11 vs.84.56±7.36,10.95±1.42;CHE(U/L):2119.43±76.80 vs.3245.52±197.26,7125.65±228.95;ALB(g/L):19.26±1.82 vs.27.91±2.65,42.54±4.28;TP(g/L):38.29±2.10 vs.51.42±2.84,73.72±4.31;all P＜0.05].In cirrhosis group,the levels of AST,ALT,ALP and TBil of Child-Pugh grade C patients were higher than those of group B and group A patients,and the levels of CHE,ALB and TP were lower than those of grade B and grade A patients[AST(U/L):72.04±9.15 vs.55.16±7.92,48.72±7.35;ALT(U/L):75.77±5.77 vs.62.54±5.13,57.29±4.82;ALP(U/L):201.56±11.72 vs.188.69±10.06,178.25±9.75;TBil(μmol/L):149.20±10.56 vs.74.59±8.95,59.86±7.82;CHE(U/L):1342.72±65.28 vs.1879.54±79.14,3136.03±85.98;ALB(g/L):17.29±1.22 vs.18.47±1.59,22.02±2.65;TP(g/L):33.54±1.31 vs.37.77±2.20,43.56±2.79,all P＜0.05].The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of combined detection of liver function indexes for the diagnosis of liver cirrhosis were 96.33%,99.00%,97.40%,99.31%and 94.74%,respectively.Conclusion The value of combined detection of liver function indicators in biochemical test for the diagnosis of liver cirrhosis is high,and it could be used for differentiation from chronic hepatitis B.
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