Assessment Of Serum Alkaline Phosphatase(ALP),γ-glutamyl Transpeptidase(GGT) And ALP/ULN Divided By GGT/ULN In The Differential Diagnosis Of Cholestatic Liver Disease

Objective:To explore the clinical application of the detection of serum alkaline phosphatase(ALP),γ-glutamyl transpeptidase(GGT)and ALP/upper limit of normal(ULN)divided by GGT/ ULN(referred to ALP~×/GGT~×)in the differential diagnosis of drug-induced cholestatic liver injury,primary biliary cholangitis(PBC),and choledocholithiasis.The above mentioned three diseases belong to cholestatic liver disease.Methods:According to the inclusion criteria and exclusion criteria,collect the inpatient medical records in the second hospital of shanxi medical university,from January 2012 to July 2016.These were classified as drug-induced cholestatic liver disease group,PBC group,choledocholithiasis group and control group.The first three groups were set for case groups.Serum ALP and GGT were examined with the rate method.Compare mean differences of above makers and draw their ROC curves among case groups.Analyse the efficacy of ALP,GGT and ALP~×/GGT~× in the differential diagnosis of drug-induced cholestatic liver injury,PBC and choledocholithiasis.Results:1.Prior to the start of the study There was no significant difference in age and sex between the groups(P>0.05).2.The level of serum ALP The level of serum ALP in the control group was significantly lower than that in the other 3 case groups(P<0.05).There were no significant differences of ALP among 3 case groups(P>0.05).3.The level of serum GGT The level of serum GGT in the control group was significantly lower than that in the other 3 case groups(P<0.05).There were significant differences of GGT among 3 case groups(P<0.05).Hovever,there was no significant difference of GGT between drug-induced cholestatic liver disease group and PBC group(P>0.05).The level of GGT of choledocholithiasis group [(424.7±317.0)U/L] was higher than those of drug-induced cholestatic liver disease group[(152.2±51.0)U/L] and PBC group[(230.5±121.0)U/L],the differences were significant(P<0.05).4.ALP/upper limit of normal(ULN)divided by GGT/ ULN(referred to ALP~×/GGT~×)The differences of ALP~×/GGT~×among groups were statistically significant(P<0.05).The level of ALP~×/GGT~×of drug-induced cholestatic liver disease group(0.95±0.54)was higher than PBC group(0.64±0.33)and choledocholithiasis group(0.37±0.18),and the PBC group was higher than choledocholithiasis group.These differences were statistically significant(P<0.05).5.The areas of ALP,GGT and ALP~×/GGT~×under the receiver operating characteristic(ROC)curves The areas of ALP,GGT and ALP~×/GGT~×in the differential diagnosis between drug-induced cholestatic liver disease group(+)and PBC group(-)were0.645,0.319,0.741,those were 0.498,0.298,0.749 between PBC group(+)and choledocholithiasis group(-),and those were 0.552,0.189,0.972 between drug-induced cholestatic liver disease group(+)and choledocholithiasis group(-).The areas of ALP~×/GGT~×were the largest.6.The sensitivity,specificity and the cut-off values of ALP~×/GGT~×The sensitivity and specificity of ALP~×/GGT~×were 90.9% and 62%,100% and 38.5%,100% and 84.6%,respectively in the differential diagnosis of drug-induced cholestasis group and PBC group,PBC group and choledocholithiasis group,drug-induced cholestasis group and choledocholithiasis group.Corresponding to the cut-off values were 0.599,0.225,0.534.Conclusion:1.Single ALP,GGT can not identify cholestatic liver disease.2.The cut-off values of ALP~×/GGT~×in the differential diagnosis of drug-induced cholestasis group and PBC group,drug-induced cholestasis group and choledocholithiasis group,PBC group and choledocholithiasis group are 0.599,0.534,0.225.