常规生化指标评估慢性肝功能损害的临床应用价值

目前国内用于诊断慢性肝功能损害的血清学检测指标很多，但对其诊断效率进行客观评价的研究并不多。目的：采用受试者工作特征曲线（ROC曲线）和诊断性能指标对常用的7项血清学指标进行综合分析，探讨其临床应用价值。方法：检测肝硬化组（n=81）、慢性肝病组（n=43）和健康对照组（n=30）的血清白蛋白（ALB）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、腺苷脱氨酶（ADA）、5’-核苷酸酶（5’-NT）、胆碱酯酶（ChE）等7个生化指标，应用ROC曲线进行分析，评价各指标的敏感性和特异性，观察不同肝病组上述指标的变化情况。结果：与慢性肝病组和健康对照组相比，肝硬化组ALB、ChE显著下降，AST显著升高（P〈0．05）；ROC曲线下面积ALB最高，ChE次之。7项指标中ChE的敏感性和特异性最高，分别为93．8％和83．7％；诊断准确率ChE最高，达90．3％，ALB次之，为89．5％。结论：临床常规的7项生化指标中，ALB和ChE最能反映肝硬化特别是肝硬化失代偿期肝功能损害程度。

Clinical Value of Conventional Biochemical Tests for Appraising Chronic Liver Damage

Background:At present,there are numerous serological tests for appraising chronic liver damage,but studies on the objective evaluation of these tests are scarce.Aims:The clinical value of 7 conventional biochemical tests for assessing chronic liver damage were appraised by receiver operating characteristic(ROC) curves and their diagnostic performance index.Methods:In patients with three groups,i.e.liver cirrhosis group(n=81),chronic liver disease group(n=43) and healthy control group(n=30),7 conventional biochemical tests were performed,namely:serum albumin(ALB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),adenosine deaminase(ADA),5'-nucleotidase(5'-NT),and cholinesterase(ChE).ROC curves were used to evaluate the sensitivity and specificity of these tests,and the variation of results of these tests among the three groups was observed.Results:Compared with chronic liver disease group and healthy control group,serum ALB and ChE decreased significantly and AST increased significantly in liver cirrhosis group(P<0.05).The area under ROC curve was the highest in ALB,ChE being the next.Of the seven biochemical tests,both the sensitivity and specificity of ChE were the highest,93.8% and 83.7%,respectively.The accurate diagnosis rate of ChE was 90.3%,followed by ALB(89.5%).Conclusions:Of the 7 conventional biochemical tests,ALB and ChE could best reflect the degree of liver damage in cirrhotic patients,especially in those with liver decompensation.