CAJ | 학술논문

目的：研究血清转氨酶水平在闭合性肝损伤患者中的表达及意义。方法回顾性研究163例闭合性腹部损伤患者的血清转氨酶水平（肝损伤79例，非肝损伤84例），观察其转氨酶水平与肝损伤的相关性。根据CT或者术中所见，将患者肝损伤进行分级，比较轻度肝损伤与重度肝损伤患者转氨酶水平的差异；根据治疗方法，分为保守治疗组和手术治疗组，比较两组患者转氨酶水平的差异。结果（1）闭合性肝损伤组患者入院时ALT水平为（358.21±77.48）U/L，AST水平为（416.32±88.00）U/L；非肝损伤组入院时ALT水平为（30.85±14.58）U/L，AST水平为（33.50±8.12）U/L，两组患者比较有统计学差异（均P=0.000）。ROC曲线显示诊断闭合性肝损伤时ALT阈值为53.00U/L，AST阈值为67.50 U/L。（2）轻度肝损伤组患者（24例）入院时ALT水平为（189.33±57.71）U/L，AST水平为（251.00±69.35）U/L；重度肝损伤组（55例）入院时ALT水平为（431.91±104.46）U/L，AST水平为（488.47±120.18）U/L。两组比较均有统计学差异（P=0.004、0.014）。（3）保守治疗组患者（52例）ALT水平为（311.10±93.03）U/L，AST水平为（367.48±103.40） U/L；手术治疗组（27例）ALT水平为（448.96±140.45）U/L，AST水平为（510.41±166.46）U/L，手术治疗组患者转氨酶水平高于保守治疗组，但无统计学差异（P=0.098、0.132）。结论闭合性腹部损伤患者升高的转氨酶水平对于闭合性肝损伤的诊断有较高的价值，显著升高的ALT水平提示严重肝损伤的发生。
목적：연구혈청전안매수평재폐합성간손상환자중적표체급의의。방법회고성연구163례폐합성복부손상환자적혈청전안매수평（간손상79례，비간손상84례），관찰기전안매수평여간손상적상관성。근거CT혹자술중소견，장환자간손상진행분급，비교경도간손상여중도간손상환자전안매수평적차이；근거치료방법，분위보수치료조화수술치료조，비교량조환자전안매수평적차이。결과（1）폐합성간손상조환자입원시ALT수평위（358.21±77.48）U/L，AST수평위（416.32±88.00）U/L；비간손상조입원시ALT수평위（30.85±14.58）U/L，AST수평위（33.50±8.12）U/L，량조환자비교유통계학차이（균P=0.000）。ROC곡선현시진단폐합성간손상시ALT역치위53.00U/L，AST역치위67.50 U/L。（2）경도간손상조환자（24례）입원시ALT수평위（189.33±57.71）U/L，AST수평위（251.00±69.35）U/L；중도간손상조（55례）입원시ALT수평위（431.91±104.46）U/L，AST수평위（488.47±120.18）U/L。량조비교균유통계학차이（P=0.004、0.014）。（3）보수치료조환자（52례）ALT수평위（311.10±93.03）U/L，AST수평위（367.48±103.40） U/L；수술치료조（27례）ALT수평위（448.96±140.45）U/L，AST수평위（510.41±166.46）U/L，수술치료조환자전안매수평고우보수치료조，단무통계학차이（P=0.098、0.132）。결론폐합성복부손상환자승고적전안매수평대우폐합성간손상적진단유교고적개치，현저승고적ALT수평제시엄중간손상적발생。
Objective To investigate liver transaminase levels in patients with blunt abdominal trauma. Methods The clinical data of 163 patients with blunt abdominal injury admitted between January 2011 and January 2013 were retrospectively analyzed. The grading of the hepatic trauma was verified using CT scans or surgical findings. The patients were managed with surgical or non- surgical approaches. Results There were 79 patients with hepatic trauma and 84 patients without hepatic trau-ma. The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in patients with hepatic trauma were sig-nificantly higher than those in patients without hepatic trauma [(358.21±77.48)U/L vs (930.85±14.58)U/L, P=0.000;and (416.32± 88.00)U/L vs (33.50±8.12)U/L, P=0.000]. In receiver operating characteristic (ROC) curve assessment, the optimum thresholds of ALT and AST in diagnosis of hepatic trauma were 53.00U/L and 67.50 U/L, respectively. The ALT and AST levels in patients with major hepatic trauma (gradesⅢ- Ⅵ, n=55) were significantly higher than those with minor hepatic trauma (grades I- Ⅱ, n=24) [(431.91±104.46)U/L vs (189.33±57.71)U/L, P=0.004 and (488.47±120.18)U/L vs (251.00±69.35)U/L, P=0.014]. There were no significant differences in ALT and AST levels between operation group and non- operation group [(448.96 ±140.45)U/L vs (311.10±93.03)U/L, P=0.098 and (510.41±166.46)U/L vs (367.48±103.40)U/L, P=0.132]. Conclusion The measurement of liver transaminase levels in patients with blunt abdominal trauma can differentiate patients with hepatic trauma from those without hep-atic trauma, and also differentiate major hepatic trauma from minor hepatic trauma.