發(fā)布時(shí)間：2018-06-23 23:29

  本文選題：膽汁淤積性肝病 + 堿性磷酸酶��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討血清堿性磷酸酶(alkaline phosphatase,ALP)、γ-谷氨酰轉(zhuǎn)肽酶(γ-glutamyl transpeptidase,GGT)及其倍值比(ALP實(shí)測(cè)值/ALP ULN)/(GGT實(shí)測(cè)值/GGT ULN)在藥物性膽汁淤積性肝損傷、原發(fā)性膽汁性膽管炎(primary biliary cholangitis,PBC)、膽總管結(jié)石這3種膽汁淤積性肝病中的鑒別價(jià)值(倍值比簡(jiǎn)稱ALP~×/GGT~×,ULN為正常范圍上限)。方法:根據(jù)納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),收集來(lái)自山西醫(yī)科大學(xué)第二醫(yī)院2012年01月至2016年07月住院患者的病例,分別設(shè)為藥物性膽汁淤積肝損傷組、PBC組、膽總管結(jié)石組、對(duì)照組,前3組為病例組。采用速率法檢測(cè)血清ALP、GGT水平。繪制ALP、GGT和ALP~×/GGT~×的受試者工作特征曲線(簡(jiǎn)稱ROC曲線),分析其鑒別藥物性膽汁淤積性肝損傷、PBC、膽總管結(jié)石的效能。結(jié)果:1.基本資料分析對(duì)照組與病例組的年齡、性別無(wú)顯著地統(tǒng)計(jì)學(xué)差異(P0.05)。2.各組間血清ALP水平的比較對(duì)照組血清ALP水平明顯低于3病例組(P0.05)。3病例組間血清ALP無(wú)顯著性統(tǒng)計(jì)學(xué)差異(P0.05)。3.各組間血清GGT水平的比較對(duì)照組血清GGT水平明顯低于3病例組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3病例組間血清GGT水平有統(tǒng)計(jì)學(xué)差異(P0.05);藥物性膽汁淤積組的血清GGT水平[(152.2±51.0)U/L]與PBC組[(230.5±121.0)U/L]的無(wú)顯著性差異(P0.05);膽總管結(jié)石組血清GGT水平[(424.7±317.0)U/L]分別高于藥物性膽汁淤積組[(152.2±51.0)U/L]和PBC組[(230.5±121.0)U/L],組間的兩兩比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.3病例組間ALP與GGT的倍值比即ALP~×/GGT~×的比較3病例組間ALP~×/GGT~×水平比較有顯著差異(P0.05);藥物性淤膽組的倍值比(0.95±0.54)大于PBC組(0.64±0.33)和膽總管結(jié)石組(0.37±0.18);PBC組的倍值比(0.64±0.33)大于膽總管結(jié)石組(0.37±0.18);組間的兩兩比較均有統(tǒng)計(jì)學(xué)意義(P0.05)。5.ALP、GGT和ALP~×/GGT~×的ROC曲線ALP、GGT和ALP~×/GGT~×鑒別藥物性膽汁淤積(陽(yáng)性組,表示為+)與PBC(陰性組,表示為-)的ROC曲線下面積分別為0.645、0.319和0.741,鑒別PBC(+)與膽總管結(jié)石性膽汁淤積(-)ROC曲線下面積分別為0.498、0.298和0.749,鑒別藥物性膽汁淤積(+)與膽總管結(jié)石性膽汁淤積(-)ROC曲線下面積分別為0.552、0.189和0.972;可以看出ALP~×/GGT~×的曲線下面積最大。6.ALP~×/GGT~×的靈敏度、特異度及臨界值(cut-off值)ALP~×/GGT~×鑒別藥物性膽汁淤積與PBC的靈敏度和特異度為90.9%和62%,鑒別PBC與膽總管結(jié)石的靈敏度和特異度為100%和38.5%,鑒別藥物性膽汁淤積與膽總管結(jié)石的靈敏度和特異度為100%和84.6%;相對(duì)應(yīng)的cut-off值分別為0.599、0.225、0.534。結(jié)論:1.ALP、GGT單一指標(biāo)不能鑒別膽汁淤積性肝病。2.ALP~×/GGT~×用于鑒別藥物性膽汁淤積與PBC、藥物性膽汁淤積與膽結(jié)石、PBC與膽總管結(jié)石的cut-off值分別是0.599、0.534和0.225。
[Abstract]:Objective: to investigate the effects of serum alkaline phosphatase (ALP), 緯 -glutamyl transpeptidase (緯 -glutamyl transpeptidase) (GGT) and its ratio of ALP / GGT on drug-induced cholestatic liver injury. The differential value of (primary biliary cholangitis and choledocholithiasis in cholestatic liver disease (ALP ~ 脳 / GGT ~ 脳 ULN is the upper limit of normal range). Methods: according to the inclusion criteria and exclusion criteria, the patients admitted from the second Hospital of Shanxi Medical University from January 2012 to July 2016 were divided into three groups: PBC group, choledocholithiasis group and control group. The first three groups were case group. The level of serum ALP GGT was detected by rate method. The operating characteristic curves (ROC curves) of ALPGGT and ALPX / GGT ~ 脳 were drawn to analyze the ability of differentiating PBC and choledocholithiasis in patients with drug-induced cholestatic liver injury. The result is 1: 1. Basic data analysis between the control group and the case group of age, gender, there was no significant statistical difference (P0.05). 2. The level of serum ALP in the control group was significantly lower than that in the 3 cases group (P0.05). There was no significant difference in serum ALP between the three groups (P0.05). 3. Comparison of serum GGT levels among groups the serum GGT levels in the control group were significantly lower than those in the 3 cases group. The serum GGT level in drug induced cholestasis group [(152.2 鹵51.0) U / L] was not significantly different from that in PBC group [(230.5 鹵121.0) U / L] (P0.05); the serum GGT level in choledocholithiasis group [(424.7 鹵317.0) U / L] was higher than that in drug group (P 0.05). Sexual cholestasis group [(152.2 鹵51.0) U / L] and PBC group [(230.5 鹵121.0) U / L], there was significant difference between the two groups (P0.05) .4.3 the double ratio of ALP and GGT between the two groups was significant difference (P0.05); the double value ratio of ALP and GGT was (0.95 鹵0.54) between the three groups (P0.05); the drug cholestasis group (0.95 鹵0.54). Compared with PBC group (0.64 鹵0.33) and choledocholithiasis group (0.37 鹵0.18), the doubling ratio of PBC group (0.64 鹵0.33) was greater than that of common bile duct stone group (0.37 鹵0.18), and the comparison between two groups had statistical significance (P0.05). And PBC (negative group, The areas under the ROC curve were 0.645U 0.319 and 0.741.The areas under the ROC curve for distinguishing PBC () from choledocholithiasis (-) were 0.4980.298 and 0.749, respectively. The difference between drug-induced cholestasis () and cholestasis of the common bile duct (-) under the ROC curve was 0.4980.298 and 0.749, respectively. The area is 0.552 ~ 0.189 and 0.972 respectively. It can be seen that the area under the curve of ALP ~ 脳 / GGT ~ 脳 is the largest. 6. The sensitivity of ALP ~ 脳 / GGT ~ 脳, The sensitivity and specificity of ALP ~ 脳 / GGT ~ 脳 in differentiating drug cholestasis from common bile duct stones were 90.9% and 62%, respectively. The sensitivity and specificity of ALP ~ 脳 / GGT ~ 脳 were 100% and 38.5% for differentiating cholestasis from choledocholithiasis, and for differentiating choledocholithiasis from choledocholithiasis. The sensitivity and specificity were 100% and 84.6%, respectively, and the corresponding cut-off values were 0.599,0.225 and 0.534, respectively. Conclusion: 1. The single index of ALPGGT can not distinguish cholestatic liver disease. 2. ALPX 脳 / GGTX is used to distinguish drug cholestasis from PBC.The cut-off values of drug cholestasis and cholelithiasis are 0.534 and 0.225, respectively.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R575

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