Mei Yong, Chen Li, Zeng Peng-Fei, Peng Ci-Jun, Wang Jun, Li Wen-Ping, Du Chao, Xiong Kun, Leng Kai, Feng Chun-Lin, Jia Ji-Hu
Department of Hepatopancreatobiliary Surgery, the Third Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China.
Diagnostics Laboratory, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China.
World J Clin Cases. 2019 Jan 26;7(2):137-144. doi: 10.12998/wjcc.v7.i2.137.
Gamma-glutamyltransferase (GGT) is one of the most important laboratory tests for the evaluation of liver damage. Through a long-term clinical observation of patients with secondary asymptomatic choledocholithiasis, we found that most patients had abnormal GGT serum levels.
To investigate the combination of serum GGT and alkaline phosphatase (ALP) in predicting the diagnosis of asymptomatic choledocholithiasis secondary to cholecystolithiasis.
In this retrospective cohort study, the clinical data of 829 patients with cholecystolithiasis admitted to the Third Affiliated Hospital of Zunyi Medical College from August 2014 to August 2017 were collected. Among these patients, 151 patients had secondary asymptomatic choledocholithiasis and served as the observation group, and the remaining 678 cholecystolithiasis patients served as the control group. Serum liver function indexes were detected in both groups, and the receiver operating characteristic (commonly known as ROC) curves were constructed for markers showing statistical significances. The cutoff value, sensitivity, and specificity of each marker were calculated according to the ROC curves.
The overall incidence of asymptomatic choledocholithiasis secondary to cholecystolithiasis was 18.2%. The results of liver function indexes including serum aspartate aminotransferase, alanine aminotransferase, direct bilirubin and total bilirubin levels showed no significant differences between the two groups ( > 0.05). However, the serum GGT and ALP levels were significantly higher in the observation group than in the control group ( < 0.05). The ROC curve analysis showed that the area under the curve was 0.881 (95%CI: 0.830-0.932), 0.647 (95%CI: 0.583-0.711) and 0.923 (95%CI: 0.892-0.953) for GGT, ALP, and GGT + ALP, respectively. The corresponding cut-off values of GGT and ALP were 95.5 U/L and 151.5 U/L, sensitivity were 90.8% and 65.1%, and specificity were 83.6% and 59.8%, respectively. The sensitivity and specificity of GGT + ALP were 93.5% and 85.1%, respectively.
An abnormally elevated serum GGT level has an important value in the diagnosis of asymptomatic choledocholithiasis secondary to cholecystolithiasis. The combination of serum GGT and ALP has better diagnostic performance. As a convenient, rapid and inexpensive test, it should be applied in secondary asymptomatic choledocholithiasis routine screening.
γ-谷氨酰转移酶（GGT）是评估肝损伤最重要的实验室检查之一。通过对继发性无症状胆总管结石患者的长期临床观察，我们发现大多数患者的GGT血清水平异常。
探讨血清GGT与碱性磷酸酶（ALP）联合检测在预测胆囊结石继发无症状胆总管结石诊断中的价值。
本回顾性队列研究收集了2014年8月至2017年8月遵义医学院第三附属医院收治的829例胆囊结石患者的临床资料。其中151例继发性无症状胆总管结石患者作为观察组，其余678例胆囊结石患者作为对照组。检测两组患者的血清肝功能指标，并对有统计学意义的指标绘制受试者工作特征（ROC）曲线。根据ROC曲线计算各指标的截断值、灵敏度和特异度。
胆囊结石继发无症状胆总管结石的总发生率为18.2%。两组患者血清天冬氨酸氨基转移酶、丙氨酸氨基转移酶、直接胆红素和总胆红素等肝功能指标结果比较，差异均无统计学意义（>0.05）。然而，观察组患者血清GGT和ALP水平显著高于对照组（<0.05）。ROC曲线分析显示，GGT、ALP及GGT+ALP的曲线下面积分别为0.881（95%CI：(0.830～0.932)）、0.647（95%CI：(0.583～0.711)）和0.923（95%CI：(0.892～0.953)）。GGT和ALP的相应截断值分别为95.5 U/L和151.5 U/L，灵敏度分别为90.8%和65.1%，特异度分别为83.6%和59.8%。GGT+ALP的灵敏度和特异度分别为93.5%和85.1%。
血清GGT水平异常升高在胆囊结石继发无症状胆总管结石的诊断中具有重要价值。血清GGT与ALP联合检测具有更好的诊断效能。作为一种简便、快速且经济的检查方法，应将其应用于继发性无症状胆总管结石的常规筛查。
