Salvatore F, Sacchetti L, Castaldo G
Dipartimento di Biochimica e Biotecnologie, Facoltà di Medicina e Chirurgia, Università degli Studi di Napoli Federico II, Italy.
Clin Chim Acta. 1997 Jan 3;257(1):41-58. doi: 10.1016/s0009-8981(96)06433-9.
We describe a series of studies on the contribution of laboratory medicine to the differential diagnosis of clinically confounding diseases in the field of chronic hepatobiliary diseases. Ascitic cholesterol and lactate dehydrogenase (LD), selected by multivariate discriminant analysis (MDA) from a multitude of serum and ascitic analytes, correctly classified 100% of patients with malignant ascites or non-malignant ascites. In addition, ascitic pseudouridine differentiated hepatocarcinoma (HC) from cirrhotic ascites with a diagnostic effectiveness (overall discrimination power) of 90%. A panel of analytes constituted by serum gamma-glutamyltransferase (GGT), the GGT isoenzyme complexed with low- and very low-density lipoprotein, aspartate aminotransferase, copper, hepatic alkaline phosphatase (AP), the LD-5 isoenzyme and alpha-fetoprotein (AFP), selected by the MDA, correctly classified 93% of about 200 cases of cirrhosis or HC. Finally, MDA also identified an equation, based on serum values of the LD-4/LD-5 and carcinoembryonic antigen/AFP ratios, AP and iron that correctly classified 96% of HC or secondary liver neoplasia cases in 100 patients. This approach based on panels of analytes selected by a sophisticated statistical analysis is a rapid and non-invasive contribution to the differential diagnosis of chronic liver disease including neoplasia.
我们描述了一系列关于检验医学在慢性肝胆疾病领域对临床混淆疾病鉴别诊断贡献的研究。通过多变量判别分析（MDA）从众多血清和腹水分析物中筛选出的腹水胆固醇和乳酸脱氢酶（LD），能正确区分100%的恶性腹水或非恶性腹水患者。此外，腹水假尿苷可区分肝癌（HC）和肝硬化腹水，诊断效能（总体判别能力）为90%。由血清γ-谷氨酰转移酶（GGT）、与低密度脂蛋白和极低密度脂蛋白结合的GGT同工酶复合物、天冬氨酸转氨酶、铜、肝碱性磷酸酶（AP）、LD-5同工酶和甲胎蛋白（AFP）组成的一组分析物，经MDA筛选，能正确区分约200例肝硬化或肝癌病例中的93%。最后，MDA还确定了一个基于LD-4/LD-5和癌胚抗原/AFP比值、AP和铁的血清值的方程，该方程能正确区分100例患者中96%的肝癌或继发性肝肿瘤病例。这种基于复杂统计分析筛选出的分析物组合的方法，是对包括肿瘤在内的慢性肝病鉴别诊断的一种快速且非侵入性的贡献。
