Role of serum alanine aminotransferase level combined with emergency bedside ultrasound in diagnosis of blunt hepatic trauma
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摘要: 目的 评价丙氨酸氨基转移酶(ALT)联合急诊床旁B超检查在闭合性肝破裂诊断中的临床应用价值,旨在探讨提高临床早期诊断准确性的有效方法。 方法 回顾性总结2013年1月—2015年5月入诸暨市人民医院疑似闭合性肝破裂患者共105例,进行急诊ALT、床旁B超和腹部CT检查,最终经CT检查或手术探查确诊闭合性肝破裂共79例(75.2%),分析急诊ALT、床旁B超以及两者联合诊断闭合性肝破裂的敏感性、特异性和准确性。 结果 闭合性肝破裂组入院6 h、12 h和24 h血清ALT水平均明显高于非肝破裂组,差异均有统计学意义(t值分别为8.43、9.17、7.54,均P<0.05)。以诊断闭合性肝破裂为标准,单一ALT、床旁B超和联合诊断为指标,分别纳入受试者工作曲线(ROC)分析得出:急诊ALT诊断的敏感性为88.6%,特异性为84.6%,准确性(曲线下面积AUC值)为0.866;急诊床旁B超诊断的敏感性为79.7%,特异性为92.3%,准确性为0.860;联合诊断的敏感性为98.7%,特异性为77.0%,准确性为0.891。 结论 ALT联合急诊床旁B超可有效提高诊断闭合性肝破裂的准确性,在早期诊断和治疗中有重要应用价值。Abstract: Objective To evaluate the clinical value of alanine aminotransferase(ALT) test combined with emergency bedside ultrasound in the diagnosis of closed rupture of liver,and explore the early effective diagnosis. Methods A total of 105 cases of suspected blunt hepatic trauma from January,2013 to May,2015 in our hospital were enrolled into this study and received emergent ALT,bedside sonography and abdominal CT examinations,and 79 of them were confirmed by CT or operation(75.2%).The sensitivity,specificity and accuracy of ALT alone,bedside sonography,and a combination of those two methods for the diagnosis of blunt hepatic trauma were compared. Results The levels of ALT at 6 h,12 h and 24 h after admission in blunt hepatic trauma group were all significantly higher than those in the non-hepatic trauma group(t=8.43,9.17,7.54,P<0.05);The sensitivity,specificity and accuracy(area under curve) of ALT along by receiver operating curve(ROC) analysis were 88.6%,84.6% and 0.866;of single bedside sonography were 79.7%,92.3% and 0.860;and of the combined group were 98.7%,77.0% and 0.891,respectively. Conclusion ALT combined with emergency bedside ultrasound can greatly improve the diagnostic accuracy of blunt hepatic trauma,which shows an important role in the early diagnosis and treatment of blunt liver injury.
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