腺苷脱氨酶活性对自身免疫性肝病的临床意义研究

摘要 目的：探讨腺苷脱氨酶（ADA）在自身免疫性肝病患者血清中的变化及其临床意义。方法：利用酶法试剂盒检测自身免疫性肝病患者血清中的总ADA（tADA）及其同工酶ADA1和ADA2的活性变化，利用受试者工作曲线（ROC）分析总ADA、ADA1及ADA2活性的诊断价值。利用Spearman相关性分析自身免疫性肝病患者各指标之间的相关性。结果：与对照组相比，tADA和ADA2活性在自身免疫性肝病患者血清中均极显著升高（P<0.001），ADA1活性有一定程度升高（P=0.035）。不同自身免疫性肝病亚型患者之间的血清tADA、ADA1及ADA2活性均无显著差异。ROC分析显示，血清tADA和ADA2活性具有诊断价值，ADA1活性无诊断价值。tADA活性截断值取13.5 U/L时，诊断特异性为93.3%，敏感性为81.2%。血清ADA2活性截断值取9.5 U/L时，诊断特异性为85.0%，敏感性为83.3%。而ADA1无显著的诊断价值，ADA活性与白蛋白球蛋白比值呈显著负相关（r=-0.41，P=0.004），与球蛋白水平具有一定程度的正相关（r=0.34，P=0.018），与ALT呈弱正相关（r=0.29，P=0.042），与其他指标的相关性均无统计学显著性。结论：血清tADA及ADA2活性在自身免疫性肝病患者血清中显著升高，并且具有一定的诊断价值。

Clinical Significance of Adenosine Deaminase Activity in Autoimmune Liver Disease

ABSTRACT Objective: To investigate the changes and clinical significance of serum adenosine deaminase activity (ADA) in patients with autoimmune liver disease (AILD). Methods: The activities of total ADA (tADA) and its isoenzymes ADA1 and ADA2 in serum of AILD patients were detected by enzyme assay. The diagnostic value of serum tADA, ADA1 and ADA2 activities were analyzed by using receiver operating curve (ROC). Spearman correlation was used to analyze the correlation among indexes in AILD patients. Results: Compared with the control group, the activities of tADA and ADA2 in serum of AILD patients were increased significantly (P<0.001), and the activity of ADA1 was increased to a certain extent (P=0.035). There were no significant differences in serum tADA, ADA1 and ADA2 activities among patients with different AILD subtypes. ROC analysis showed that serum tADA and ADA2 activities had diagnostic value. When the tADA activity cut-off value was 13.5 U/L, the diagnostic specificity and sensitivity were 93.3% and 81.2% respectively. When the cut-off value of serum ADA2 activity was 9.5 U/L, the diagnostic specificity and sensitivity were 85.0% and 83.3% respectively. ADA1 has no significant diagnostic value. ADA activity was correlated negatively with albumin globulin ratio (r=-0.41, P=0.004), correlated positively with globulin level to a certain extent (r=0.34, P=0.018), correlated weakly with ALT (r=0.29, P=0.042), and had no statistical significance with other hepatic function indexes. Conclusion: Serum tADA and ADA2 activities were increased significantly in AILD patients, and it could be a diagnostic biomarker for AILD.