血清钾、钠联合肝转氨酶在钝性肝损伤中的临床价值研究

目的探讨血清钾、钠联合肝转氨酶在钝性肝损伤中的临床应用价值。方法回顾性分析2003年10月—2016年4月福州总医院收治的202例钝性肝脾损伤患者的临床资料。按是否存在肝损伤分为肝损伤组101例,无肝损伤组即脾损伤组101例;按肝损伤程度分为轻度肝损伤组53例,严重肝损伤组48例。检测两组血清钾(K~+)、血清钠(Na~+)、谷丙转氨酶(ALT)、谷草转氨酶(AST)的值,通过Logistic回归建立回归模型,绘制受试者工作特征曲线(ROC曲线)并计算曲线下面积(AUC)以评价单独及联合指标检测的诊断价值。通过ROC曲线确定ALT、AST在肝损伤中的最佳阈值及血清K~+、Na~+、ALT、AST在严重肝损伤中的最佳阈值。结果肝损伤与无肝损伤组血清K~+、Na~+、ALT、AST水平四种指标的差异有统计学意义(P0.01);轻度与严重肝损伤组四种指标水平的差异有统计学意义(P0.01)。对于判断闭合性腹部损伤是否合并肝损伤,联合指标检测的AUC大于单独检测的AUC,但差异无统计学意义(P0.05);ALT单独和联合检测对肝损伤和非肝损伤的预测率分别为89.1%、94.1%;ALT单独判断肝损伤的敏感度和特异度分别为92.1%、93.1%,而联合检测则分别为93.1%、93.1%。对于判断钝性肝损伤是否为严重肝损伤,联合检测的AUC大于单独检测的AUC,且差异有统计学意义(P=0.043);ALT单独检测对轻度肝损伤和严重肝损伤的预测率分别为79.2%、58.3%,而联合则分别为81.1%、70.8%;ALT单独检测判断严重肝损伤的敏感度和特异度分别为83.3%、54.7%,而联合则分别为66.7%、94.3%。通过ROC曲线评估得出ALT、AST在肝损伤中的最佳阈值分别为57.55U/L、59.2U/L;血清K~+、Na~+、ALT、AST在严重肝损伤中的最佳阈值分别为3.685mmol/L、142.55mmol/L、171.50U/L、364.00U/L。血清K~+和Na~+水平在轻度和严重肝损伤组呈负相关(P=0.005,r=-0.382;P=0.001,r=-0.494),且在严重肝损伤中最为明显。结论肝转氨酶升高与肝损伤密切相关;肝功能联合电解质检测对临床鉴别钝性肝损伤是否为严重肝损伤有较高的准确性、预测性和特异度,可作为临床早期鉴别的一种初步有效的手段之一,从而为其治疗提供有力的证据。

Clinical value of serum potassium and sodium combined hepatic transaminases in the blunt liver injury

Objective To investigate the clinical application value of serum potassium and sodium com-bined hepatic transaminases in the blunt liver injury .Methods Clinical data of 202 patients with blunt liver and spleen injury admitted between Oct .2003 and Apr.2016 in the Fuzhou General Hospital were reviewed retrospec-tively.According to the presence or absence of liver injury ,they were divided into liver injury group and non-liver in-jury group, with 101 cases in each group.In the liver injury group,53 cases of mild liver injury were taken as the mild liver injury group and 48 cases of severe liver injury were taken as the severe liver injury group .Values of ser-um potassium,sodium,alanine aminotransferase(ALT) and aspartate aminotransferase(AST) in the two groups were detected,and the regression model was established by Logistic regression to draw receiver operating characteristic curve to evaluate the diagnostic value of individual and joint detection indicators .The optimal threshold of ALT and AST in liver injury and serum potassium ,sodium,ALT and AST in severe liver injury were determined by the ROC curve.Results Four metric levels were statistically significant (P<0.01) between non-liver injury group and liver injury group,and were statistically significant (P <0.01) between mild liver injury group and severe liver injury group.AUC of combined detection was greater than single detection for judging the presence or absence of liver injury in the blunt abdominal injury,but the difference was not statistically significant (P>0.05).Prediction rates of ALT alone and combined detection were 89.1% and 94.1% for the presence of liver injury , respectively,and sensitivity and specificity of ALT alone for determination of liver injury were 92.1% and 93.1%, respectively , but combined were 93.1%and 93.1%.AUC of combined detection was greater than single detection for judging the presence or ab -sence of severe liver injury in the blunt liver injury and the difference was statistically significant (P=0.043),predic-tion rates of ALT alone detection were 79.2% and 58.3%, respectively ,but combined were 81.1% and 70.8% for the mild liver injury and severe liver injury ,and sensitivity and specificity of ALT alone for determination of liver inju-ry were 83.3%and 54.7%, respectively,but combined were 66.7%and 94.3%.This study obtained that of the opti-mal threshold of ALT,AST in liver injury were 57.55U/L and 59.20U/L, respectively,and that the optimal threshold of serum potassium,sodium,ALT and AST of severe liver injury were 3.685mmol/L,142.55mmol/L,171.50U/L and 364.00U/L, respectively by the ROC curve assessment .Levels of serum potassium and sodium are negatively correla-ted in mild liver injury and severe liver injury(P=0.005,r=-0.382;P=0.001,r=-0.494),especially significant in severe liver injury .Conclusion Increased liver transaminases are closely related to liver damage .Combined elec-trolytes detection of liver function for clinical identification of whether liver injury is severe has high accuracy ,predict-ability and specificity in the blunt liver injury ,which could be used as one of the initial effective means for early clini-cal judgment of whether blunt liver injury is severe ,so as to provide strong evidence for its clinical treatment .