GGT、ALP和外周血NLR联合检测在肝癌诊断中的应用价值

目的 探讨γ-谷氨酰转移酶（γ-glutamyltransferase，GGT）、碱性磷酸酶（alkaline phosphatase，ALP）和外周血中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）联合检测在肝癌诊断中的应用价值。方法 回顾性选取2012年1月至2020年12月广西医科大学附属武鸣医院收治的100例肝癌患者纳入肝癌组，100例肝硬化患者纳入肝硬化组，100例肝炎患者纳入肝炎组，另选取本院同期健康体检者100人纳入健康体检组。比较四组受试者的GGT、ALP、NLR水平，采用受试者操作特征曲线（receiver operating characteristic curve，ROC曲线）评价各指标对肝癌的诊断效能。 结果 肝癌组患者的NLR、GGT和ALP水平均显著高于肝硬化组、肝炎组和健康体检组（P<0.05）；肝硬化组患者的NLR显著高于健康体检组和肝炎组（P<0.05）；肝硬化组和肝炎组患者的GGT和ALP均显著高于健康体检组（P<0.05）。Spearman相关分析结果显示，NLR与GGT、ALP均呈正相关，GGT与ALP呈正相关（P<0.05）。NLR、GGT和ALP单独检测诊断肝癌时，NLR的曲线下面积（area under the curve，AUC）最大，为0.943（95%CI：0.901~0.971，P<0.001），ALP的AUC最小。三者联合检测的AUC为0.987（95%CI：0.959~0.998），敏感度为99.0%。结论 NLR、GGT、ALP联合检测可显著提高肝癌的检出率，联合检测有更好的应用价值。

Application value of combined detection of GGT, ALP and peripheral blood NLR in the diagnosis of liver cancer

Objective To investigate the application value ofγ-glutamyltransferase (GGT), alkaline phosphatase (ALP) and peripheral blood neutrophil to lymphocyte ratio (NLR) in liver cancer. Methods 100 patients with liver cancer admitted to Wuming Hospital Affiliated to Guangxi Medical University from January 2012 to December 2020 were retrospectively selected to be included in liver cancer group, 100 patients with cirrhosis to be included in cirrhosis group, 100 patients with hepatitis to be included in hepatitis group, and 100 healthy physical examination subjects from our hospital during the same period were included in physical examination group. The GGT, ALP and NLR levels of the four groups were compared. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of each index for liver cancer. Results The levels of NLR, GGT and ALP in liver cancer group were significantly higher than those in cirrhosis group, hepatitis group and physical examination group (P<0.05). The NLR in cirrhosis group was significantly higher than that in physical examination group and hepatitis group (P<0.05). GGT and ALP in cirrhosis group and hepatitis group were significantly higher than those in physical examination group (P<0.05). Spearman correlation analysis showed that NLR was positively correlated with GGT and ALP, and GGT was positively correlated with ALP (P<0.05). When NLR, GGT and ALP were detected separately, area under the curve (AUC) of NLR was the largest (0.943, 95%CI: 0.901-0.971, P<0.001), and AUC of ALP was the smallest. The AUC of three combined detections was 0.987 (95%CI: 0.959-0.998), and the sensitivity was 99.0%. Conclusion The combined detection of NLR, GGT and ALP can significantly improve the detection rate of liver cancer, and the combined detection has better application value.