术前肝功能指标在急性结石性胆囊炎合并胆总管结石中的诊断价值

目的 探讨术前肝功能相关指标在急性结石性胆囊炎合并胆总管结石中的诊断价值。方法 回顾性分析苏州大学附属第三医院2015 年3 月至2019 年4 月收治的急性结石性胆囊炎患者319 例，其中单纯急性结石性胆囊炎患者204 例，急性结石性胆囊炎合并胆总管结石患者115 例；采用秩和检验比较两组患者术前肝功能相关指标（TBIL、DBIL、ALT、AST、GGT、ALP、LDH、TBA）的差异，通过ROC曲线分析各指标的诊断敏感性、特异性及相应的诊断临界值，明确其对急性结石性胆囊炎合并胆总管结石的诊断价值。结果 单纯急性结石性胆囊炎患者与急性结石性胆囊炎合并胆总管结石患者TBIL [13.25（9.63，20.78）μmol/L vs 34.60（20.40，55.40）μmol/L]、DBIL [5.85（4.10，9.00）μmol/L vs 22.60（10.20，42.30）μmol/L]、ALT [25.00 （15.25，39.00）IU/L vs 211.00（93.00，374.00）IU/L]、AST [23.00（17.00，36.50）IU/L vs 141.00（52.00，276.00）IU/L]、GGT [40.50（22.00，91.00）IU/L vs 315.00（155.00，520.00）IU/L]、ALP [85.00（69.00，116.50）IU/L vs 168.00（119.00，248.00）IU/L]、LDH [202.00（169.00，234.75）IU/L vs 236.00（176.00，352.00）IU/L]、TBA [5.20（2.63，9.10）μmol/L vs 43.60（6.70，146.50）μmol/L]均具有统计学差异（P＜0.05）。ROC曲线分析显示，TBIL、DBIL、ALT、AST、GGT、ALP、LDH、TBA特异性分别为69.6%、78.4%、87.3%、85.8%、81.4%、71.6%、82.8%、88.7%；敏感性分别为81.7%、80.0%、77.4%、77.4%、82.6%、82.6%、45.2%、65.2%；临界值分别为18.3 μmol/L、9.4 μmol/L、81.0 IU/L、50 IU/L、119 IU/L、106 IU/L、254 IU/L、18.9 μmol/L。结论 术前血清肝功能相关指标对急性结石性胆囊炎合并胆总管结石具有重要的诊断价值，当高于其相应的临界值及指标异常数目≥5个时诊断价值更大。

Diagnostic value of preoperative liver function indexes in acute calculous cholecysyitis combined with common bile duct stones

Objective To evaluate the diagnostic value of preoperative liver function indexes in acute calculous cholecystitis combined with common bile duct stones. Methods A total of 319 patients with acute calculous cholecystitis admitted to the Third Affiliated Hospital of Soochow University from Mar. 2015 to Apr. 2019 were collected, including 204 patients with simple acute calculous cholecystitis and 115 patients with acute calulous cholecystitis and common bile duct stones. The rank-sum test was used to compare the differences of preoperative liver function indexes (TBIL, DBIL, ALT, AST, GGT, ALP, LDH, TBA) between the two groups. The sensitivity, specificity and corresponding diagnostic threshold of each index were analyzed by ROC curve, to determine its diagnostic value for acute calculous cholecystitis combined with common bile duct stones. Results There were statistically significant differences in TBIL [13.25(9.63, 20.78)μmol/L vs 34.60(20.40, 55.40)μmol/L], DBIL [5.85(4.10, 9.00)μmol/L vs 22.60(10.20, 42.30)μmol/L], ALT [25.00(15.25, 39.00)IU/L vs 211.00(93.00, 374.00)IU/L], AST [23.00(17.00, 36.50)IU/L vs 141.00(52.00, 276.00)IU/L], GGT [40.50(22.00, 91.00)IU/L vs 315.00(155.00, 520.00)IU/L], ALP [85.00(69.00, 116.50)IU/L vs 168.00(119.00, 248.00)IU/L], LDH[202.00(169.00, 234.75)IU/L vs 236.00(176.00, 352.00)IU/L] and TBA [5.20(2.63, 9.10)μmol/L vs 43.60(6.70,146.50)μmol/L] between patients with simple acute calculous cholecystitis and patients with acute calculous cholecystitis and common bile duct stones (P<0.05). ROC curve analysis showed that the specificity of TBIL, DBIL, ALT, AST, GGT, ALP, LDH, and TBA was 69.6%, 78.4%, 87.3%, 85.8%, 81.4%, 71.6%, 82.8% and 88.7%, respectively|the sensitivity was 81.7%, 80.0%, 77.4%, 77.4%, 82.6%, 82.6%, 45.2%, and 65.2%, respectively|and the diagnostic threshold value was 18.3 μmol/L, 9.4 μmol/L, 81.0 IU/L, 50 IU/L, 119 IU/L, 106 IU/L, 254 IU/L, and 18.9 μmol/L, respectively. Conclusion The preoperative serum liver function indexes have important diagnostic value for acute calculous cholecystitis compbined with common bile duct stones, and the diagnostic value is greater when the index level higher than the corresponding critical value or the number of abnormal indexes≥5.