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血清肝功能指标对胆囊结石合并无症状继发性胆总管结石的诊断价值

Diagnostic value of serum liver function indexes for gallbladder stones combined with asymptomatic secondary common bile duct stones

摘要:

目的 探讨异常血清肝功能指标对胆囊结石合并无症状继发性胆总管结石的诊断价值.方法 采用回顾性队列研究方法.收集2012年6月至2016年6月遵义医学院附属医院收治的460例胆囊结石患者的临床资料.其中106例患者合并无症状继发性胆总管结石,设为胆总管结石组;354例单纯胆囊结石患者,设为胆囊结石组.检测两组患者血清肝功能指标:ALT、AST、TBil、DBil、GGT、ALP,选取有统计学意义指标构建受试者工作特征(ROC)曲线.根据ROC曲线计算各指标的临界值、灵敏度和特异度.观察指标:(1)两组患者血清肝功能指标(ALT、AST、TBil、DBil、GGT、ALP)比较.(2) ROC曲线分析结果.正态分布的计量资料以-x±s表示,组间比较采用独立样本t检验.计数资料组间比较采用x2检验.有统计学意义的指标进一步行ROC曲线分析.结果 (1)两组患者血清肝功能指标比较:胆总管结石组患者血清ALT、AST、TBil及DBil分别为(32±8) U/L、(35±8) U/L、(12.8±2.5) μmol/L、(2.6±0.4)μmol/L,胆囊结石组分别为(30±7) U/L、(32±7) U/L、(12.2±2.4) μmol/L、(2.5±0.4) μmol/L,两组患者上述指标比较,差异均无统计学意义(t=0.891,0.786,0.924,1.026,P>0.05).胆总管结石组患者血清GGT和ALP分别为(162±43) U/L、(145±37) U/L,胆囊结石组分别为(36± 10) U/L、(128±23) U/L,两组患者上述指标比较,差异均有统计学意义(t=20.859,2.483,P<0.05).(2) ROC曲线分析结果显示:GGT和ALP对应曲线下面积分别为0.963(95%可信区间:0.938~0.988)和0.621(95%可信区间:0.561~0.684),诊断准确度最高的临界值分别为92.5 U/L和139.5 U/L,灵敏度分别为91.6%和50.7%,特异度分别为95.7%和76.5%.结论 血清GGT的异常升高对胆囊结石合并无症状继发性胆总管结石有较重要的临床诊断价值,且操作方便、快速,值得在临床应用及推广.

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abstracts:

Objective To investigate the diagnostic value of serum liver function indexes for gallbladder stones combined with asymptomatic secondary common bile duct stones.Methods The retrospective cohort study was conducted.The clinical data of 460 patients with gallbladder stones who were admitted to the Affiliated Hospital of Zunyi Medical College from June 2012 to June 2016 were collected.Of 460 patients,106 combined with asymptomatic secondary common bile duct stones and 354 with gallbladder stones were allocated into the common bile duct stone group and gallbladder stone group,respectively.The serum liver function test was applied to the 2 groups,including alanine transaminase (ALT),aspartate transaminase (AST),total bilirubin (TBil),direct bilirubin (DBil),glutamyltransferase (GGT) and alkaline phosphatase (ALP).The receiver operating characteristic (ROC) curve was built using significant statistical indicators,and correspondent cut-off value,sensitivity and specificity were calculated according to ROC curve.Observation indicators:(1) comparison of serum liver function indicators (ALT,AST,TBil,DBil,GGT,ALP) between the 2 groups;(2) analysis result of ROC curve.Measurement data with normal distribution was represented as x±s.The comparison between groups was evaluated with the independent-sample t test.The comparison of count data were analyzed using the chi-square test.The ROC curve analysis was done for significant statistical indicators.Results (1) Comparison of serum liver function indicators between the 2 groups,the levels of ALT,AST,TBil and DBil were (32±8)U/L,(35±8)U/L,(12.8±2.5)μmol/L,(2.6±0.4)μmol/L in the common bile duct stone group and (30±7)U/L,(32±7)U/L,(12.2± 2.4)μmol/L,(2.5 ±0.4)μmol/L in the gallbladder stone group,respectively,with no statistically significant difference (t=0.891,0.786,0.924,1.026,P>0.05).The levels of GGT and ALP were (162±43) U/L and (145±37) U/L in the common bile duct stone group and (36± 10)U/L and (128±23) U/L in the gallbladder stone group,respectively,with significantly statistical differences (t =20.859,2.483,P<0.05).(2) Result of ROC curve showed that areas under the curve of GGT and ALP were respectively 0.963 [95% confidence interval (CI):0.938-0.988] and 0.621 (95%CI:0.561-0.684).The correspondent cut-off value of diagnostic accuracy,sensitivity and specificity of GGT and ALP were 92.5 U/L and 139.5 U/L,91.6% and 50.7%,95.7% and 76.5%,respectively.Conclusion The abnormally elevated levels of serum GGT have major diagnostic value for patients with gallbladder stones combined with asymptomatic secondary common bile duct stones,with an advantage of convenient and fast operation,and it is worth to be applied and popularized.

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作者: 顾进 [1] 涂奎 [1] 王芳 [1] 赵礼金 [1]
期刊: 《中华消化外科杂志》2017年16卷2期 183-187页 ISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.1673-9752.2017.02.014
发布时间: 2017-03-15
基金项目:
国家自然科学基金(81260085)National Natural Science Foundation of China
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