血清总胆汁酸测定的意义及其局限性

目的　阐明空腹血清总胆汁酸（TBA）测定的临床意义。方法　收集913例临床资料，用SPSS软件及四格表法进行统计分析。结果　（1）正常人TBA平均（4.0±3.2）μmol/L。肝病组TBA显著高于正常人和非肝病组(P＜0.01)。（2）急性肝炎患者TBA平均为（167.2±132.4）μmol/L，最高达449.5μmol/L，与其他各组相比差异有显著性(P＜0.01)，表明TBA是反映急性肝细胞损伤的敏感指标。（3）TBA对肝硬化的敏感性为85.8%，优于其他肝功能试验，TBA是反映肝硬化侧支循环的有价值的指标。（4）TBA对慢性轻度肝炎的敏感性仅为30.5%，不及ALT和总胆红素（TBIL）。（5）TBA水平与病情轻重有一定关系，但与TBIL不完全平行，对病情的判断不如TBIL有价值。结论　TBA特异性高，敏感性尚可，对肝病、特别是急性肝炎和肝硬化有重要诊断价值，但对慢性轻度肝炎的敏感性差，对病情的判断不如TBIL有意义。

The diagnostic value and limitations of total serum bile acid determined enzymatically

OBJECTIVE: To elucidate the diagnostic value of total serum bile acid. METHOD: Clinical data from 913 cases was statistically analyzed with SPSS for Windows and other statistical procedures reported previously. RESULTS: (1) The mean of TBA of healthy subjects was (4.0 +/- 3.2) micromol/L. The TBA level of liver disease group is significantly higher than other group(P < 0.01). (2) The mean of TBA of patients with acute hepatitis was (167.2 +/- 132.4) micromol/L, the highest value was 449.5 micromol/L, it was significantly higher than other groups. TBA was a sensitive mark reflecting acute hepatic injury. (3) The sensitivity of TBA in patients with cirrhosis was 85.8%, higher than routine liver function tests. TBA is a valuable mark reflecting collateral circulation. (4) The sensitivity of TBA in mild chronic hepatitis was only 30.5%, much lower than ALT and TBIL (P < 0.01). (4) There was a relationship between the level of TBA and the severity of patients' condition, but the value of TBA for evaluating the severity was not as good as TBIL. CONCLUSION: The specificity of TBA is quite high, the sensitivity is moderate, TBA is valuable for the diagnosis of liver disease, especially for acute hepatitis and cirrhosis, but it's sensitivity for mild chronic hepatitis is only 30.5%, it is not as good as TBIL for evaluating the condition of patients.