Pyati Anand K, Halappa Chandrakanth K, Pyati Sudharani A, Wali Vinod
Assistant Professor, Department of Biochemistry, Belagavi Institute of Medical Sciences , Belagavi, Karnataka, India .
Associate Professor, Department of Biochemistry, Subbaiah Institute of Medical Sciences , Shimoga, Karnataka, India .
J Clin Diagn Res. 2015 Nov;9(11):BC12-5. doi: 10.7860/JCDR/2015/15917.6850. Epub 2015 Nov 1.
The diagnostic accuracy of currently available standard panel of liver function tests is not satisfactory for the reliable diagnosis of chronic liver disorders. Earlier studies have reported that serum basal paraoxonase 1 (PON1) activity measurement may add a significant contribution to the liver function tests.
To assess whether the measurement of serum basal paraoxonase 1 (PON1) activity would be useful as an index of liver function status in chronic hepatitis patients.
The study included 50 chronic hepatitis patients and 50 apparently healthy controls based on inclusion & exclusion criteria. In all the subjects, standard liver function tests were analysed by using standard methods. Basal PON1 activity was estimated using spectrophotometric method by the hydrolysis of p-nitrophenylacetate. Student t-test, Pearson's correlation coefficient, diagnostic validity tests and ROC curve analysis were the methods used for the statistical analysis of the data.
The serum basal PON1 activity was significantly decreased in chronic hepatitis cases when compared to controls (p< 0.001). Also basal PON1 activity was positively correlated with serum total protein and albumin, and negatively correlated with serum total bilirubin, alanine amino transferase (ALT), and alkaline phosphatase (ALP) (p< 0.001) in chronic hepatitis cases but not in healthy controls. Diagnostic validity tests showed, basal PON1 activity was a better discriminator of chronic hepatitis than total protein, albumin and ALP with sensitivity of 68%, specificity of 100%, positive predictive value of 100% and negative predictive value of 75%. ROC curve analysis demonstrated highest diagnostic accuracy for ALT (AUC = 0.999) followed by PON1 (AUC = 0.990), total bilirubin (AUC = 0.977), ALP (AUC = 0.904), total protein (AUC = 0.790) and albumin (AUC = 0.595).
Diagnostic accuracy of serum PON1 activity is better than total bilirubin, total protein, albumin and ALP. PON1 activity measurement could significantly improve the current efficiency of a laboratory's evaluation of patients with suspected chronic hepatitis.
目前可用的标准肝功能检查组合对于慢性肝脏疾病的可靠诊断，其诊断准确性并不令人满意。早期研究报告称，血清基础对氧磷酶1（PON1）活性测量可能会对肝功能检查有显著贡献。
评估血清基础对氧磷酶1（PON1）活性测量作为慢性肝炎患者肝功能状态指标是否有用。
根据纳入和排除标准，该研究纳入了50例慢性肝炎患者和50例明显健康的对照者。对所有受试者，采用标准方法分析标准肝功能检查项目。通过对硝基苯乙酸水解，采用分光光度法估算基础PON1活性。采用学生t检验、皮尔逊相关系数、诊断效度检验和ROC曲线分析对数据进行统计分析。
与对照组相比，慢性肝炎病例的血清基础PON1活性显著降低（p<0.001）。在慢性肝炎病例中，基础PON1活性与血清总蛋白和白蛋白呈正相关，与血清总胆红素、丙氨酸氨基转移酶（ALT）和碱性磷酸酶（ALP）呈负相关（p<0.001），但在健康对照中无此相关性。诊断效度检验显示，基础PON1活性比总蛋白、白蛋白和ALP对慢性肝炎有更好的鉴别能力，敏感性为68%，特异性为100%，阳性预测值为100%，阴性预测值为75%。ROC曲线分析表明，ALT的诊断准确性最高（AUC = 0.999），其次是PON1（AUC = 0.990）、总胆红素（AUC = 0.977）、ALP（AUC = 0.904）、总蛋白（AUC = 0.790）和白蛋白（AUC = 0.595）。
血清PON1活性的诊断准确性优于总胆红素、总蛋白、白蛋白和ALP。PON1活性测量可显著提高实验室当前对疑似慢性肝炎患者评估的效率。
