Assessment Of Serum ALP/ULN Divided By GGT/ULN?Total Bile Acid?5'-Nucleotidase In The Diagnosis Of Different Cholestatic Liver Diseases

Objective:To study the clinical detection of serum alkaline phosphatase(ALP),?-glutamyl transpeptidase(GGT),5'-Nucleotidase(5-NU),Total bile acid(TBA),and ALP/upper limit of normal(ULN)divided by GGT/ULN(Abbreviated as ALP~×/GGT~×)in the diagnosis of different cholestasis,such as drug-induced cholestasis,primary biliary cholangitis(PBC)and choledocholithiasis.Methods:According to the inclusion and exclusion criteria,collect the cases from inpatient records in the second hospital of shanxi medical university,from Jan 2012 to Dec.2017.The patients were classified as drug-induced cholestasis group,PBC group,choledocholithiasis group and control group.Serum ALP,GGT,5'–NU and TBA were examined with the rate method.Compare the mean difference of above makers,and draw its ROC curves in pairs of three cholestasis's diseases each other.And obtain the cut-off value of ALP,GGT and ALP~×/GGT~×in drug-induced cholestasis,PBC and choledocholithiasis.Results:1.There was no statistically significant difference in the gender and age among all groups about the basic data(P>0.05).2.There was no statistically significant difference of GGT level between PBC and drug-induced cholestasis groups.GGT level of choledocholithiasis was higher than PBC and drug-induced cholestasis(P?0.05).The level of GGT of choledocholithiasis group was 484.7±217.0 U/L and drug-induced cholestatic group 152.2±51.0 U/L and PBC group 246.5±158 U/L(P?0.05).3.There was no significant difference in serum ALP levels among the experimental groups(P>0.05).and they were higher than that of control group(P<0.05).4.There was no significant difference in serum levels of 5'-NU between PBC and drug-induced cholestatic group(P>0.05).5'-NU level of choledocholithiasis was higher than PBC and drug-induced cholestasis(P?0.05).5.TBA level of drug-induced cholestasis was higher than choledocholithiasis and PBC(P?0.05).6.There was significant difference in ALP~×/GGT~×value in pairs of three experimental groups(P?0.05).7.The areas of receiver operating characteristic(ROC)curve in GGT,ALP and ALP~×/GGT~×were 0.351?0.636?0.813 between drug-induced cholestatic and PBC each other to identify.That of others were 0.328?0.487?0.687 between PBC and choledocholithiasis,and another were 0.170?0.574?0.976 between drug-induced cholestatic and choledocholithiasis group.The area of ALP~×/GGT~×was the largest.8.The cut-off value,sensitivity and specificity of ALP~×/GGT~×were 0.60,95.0%and58.5%respectively between drug-induced cholestasis distinguished from PBC group.So were 0.27,96.0%and 37.5%between PBC distinguished from choledocholithiasis group.So were 0.534,100%and 98%between drug-induced cholestasis distinguished from choledocholithiasis group.Conclusion:1.Serum level of 5'-NU and GGT in choledocholithiasis were significantly higher than those in PBC and drug-induced cholestasis.2.The serum level of TBA in drug-induced cholestasis was significantly higher than that of PBC and choledocholithiasis.3.There were not significant differences in ALP level among PBC,drug-induced and choledocholithiasis cholestasis.4.There were significant differences in mean compare of ALP~×/GGT~×in pairs of PBC,drug-induced and choledocholithiasis cholestasis.5.The cut-off value,sensitivity and specificity of ALP~×/GGT~×of drug-induced cholestasis distinguished from PBC were 0.60,95.0%and 58.5%.So were 0.27,96.0%and 37.5%between PBC distinguished from choledocholithiasis group.So were 0.534,100%and 98%between drug-induced cholestasis distinguished from choledocholithiasis group.