Whitfield John B, Masson Steven, Liangpunsakul Suthat, Hyman Jessica, Mueller Sebastian, Aithal Guruprasad, Eyer Florian, Gleeson Dermot, Thompson Andrew, Stickel Felix, Soyka Michael, Daly Ann K, Cordell Heather J, Liang Tiebing, Foroud Tatiana, Lumeng Lawrence, Pirmohamed Munir, Nalpas Bertrand, Bence Camille, Jacquet Jean-Marc, Louvet Alexandre, Moirand Romain, Nahon Pierre, Naveau Sylvie, Perney Pascal, Podevin Philippe, Haber Paul S, Seitz Helmut K, Day Christopher P, Mathurin Philippe, Morgan Timothy M, Seth Devanshi
Genetic Epidemiology, QIMR Berghofer Medical Research Institute, Queensland 4029, Australia.
Faculty of Medical Sciences, Newcastle University Medical School, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom.
Alcohol. 2018 Feb;66:1-7. doi: 10.1016/j.alcohol.2017.07.006. Epub 2017 Sep 23.
Laboratory tests can play an important role in assessment of alcoholic patients, including for evaluation of liver damage and as markers of alcohol intake. Evidence on test performance should lead to better selection of appropriate tests and improved interpretation of results. We compared laboratory test results from 1578 patients between cases (with alcoholic cirrhosis; 753 men, 243 women) and controls (with equivalent lifetime alcohol intake but no liver disease; 439 men, 143 women). Comparisons were also made between 631 cases who had reportedly been abstinent from alcohol for over 60 days and 364 who had not. ROC curve analysis was used to estimate and compare tests' ability to distinguish patients with and without cirrhosis, and abstinent and drinking cases. The best tests for presence of cirrhosis were INR and bilirubin, with areas under the ROC curve (AUCs) of 0.91 ± 0.01 and 0.88 ± 0.01, respectively. Confining analysis to patients with no current or previous ascites gave AUCs of 0.88 ± 0.01 for INR and 0.85 ± 0.01 for bilirubin. GGT and AST showed discrimination between abstinence and recent drinking in patients with cirrhosis, including those without ascites, when appropriate (and for GGT, sex-specific) limits were used. For AST, a cut-off limit of 85 units/L gave 90% specificity and 37% sensitivity. For GGT, cut-off limits of 288 units/L in men and 138 units/L in women gave 90% specificity for both and 40% sensitivity in men, 63% sensitivity in women. INR and bilirubin show the best separation between patients with alcoholic cirrhosis (with or without ascites) and control patients with similar lifetime alcohol exposure. Although AST and GGT are substantially increased by liver disease, they can give useful information on recent alcohol intake in patients with alcoholic cirrhosis when appropriate cut-off limits are used.
实验室检查在酒精性肝病患者的评估中发挥着重要作用，包括评估肝损伤以及作为酒精摄入量的标志物。关于检查性能的证据应有助于更好地选择合适的检查并改善对结果的解读。我们比较了1578例患者的实验室检查结果，其中病例组（患有酒精性肝硬化；753名男性，243名女性）和对照组（终生酒精摄入量相当但无肝病；439名男性，143名女性）。还对据报道已戒酒超过60天的631例患者和未戒酒的364例患者进行了比较。采用ROC曲线分析来估计和比较各项检查区分有或无肝硬化患者以及戒酒和饮酒患者的能力。诊断肝硬化的最佳检查是国际标准化比值（INR）和胆红素，其ROC曲线下面积（AUC）分别为0.91±0.01和0.88±0.01。将分析局限于无当前或既往腹水的患者时，INR的AUC为0.88±0.01，胆红素的AUC为0.85±0.01。当使用适当（且针对γ-谷氨酰转移酶有性别特异性）的限值时，γ-谷氨酰转移酶（GGT）和谷草转氨酶（AST）可区分肝硬化患者（包括无腹水者）的戒酒和近期饮酒情况。对于AST，临界值为85单位/升时，特异性为90%，敏感性为37%。对于GGT，男性临界值为288单位/升，女性为138单位/升时，二者特异性均为90%，男性敏感性为40%，女性为63%。INR和胆红素在酒精性肝硬化患者（有或无腹水）与终生酒精暴露量相似的对照患者之间显示出最佳区分度。尽管AST和GGT会因肝病而大幅升高，但当使用适当的临界值时，它们可为酒精性肝硬化患者的近期酒精摄入量提供有用信息。
