本文選題：肝活素 + 肝損傷　； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探究肝活素(HPS)在阻塞性黃疸所致肝損傷的診斷以及慢性肝病肝功能評估中的作用。方法:隨機(jī)選擇60例阻塞性黃疸患者、68例慢性肝病患者及30例健康體檢者,ELISA法測定其血清HPS水平,丙氨酸氨基轉(zhuǎn)移酶(ALT)、總膽紅素(TBIL)、血漿白蛋白(ALB)、凝血酶原時(shí)間(PT)由我院檢驗(yàn)科檢測。根據(jù)得出的TBIL、ALB、PT綜合有無肝性腦病和腹水對慢性肝病患者中無肝衰竭患者進(jìn)行Child-Pugh分級(CPC),發(fā)生肝衰竭的患者則根據(jù)衰竭類型分組。68例慢性肝病患者,非肝衰竭者Child A級13例、Child B級21例、Child C級10例,肝衰竭者中CLF者13例,ACLF者11例。分析兩種肝損傷患者與正常人血清HPS水平有無差異;繪制受試者工作特征曲線(ROC),通過觀察AUC大小判斷HPS對阻塞性黃疸所致肝損傷的診斷價(jià)值;對阻塞性黃疸患者血清HPS和ALT進(jìn)行相關(guān)性分析;分析慢性肝病患者HPS與CPC以及肝衰竭之間的關(guān)系。結(jié)果:1.阻塞性黃疸和慢性肝病患者血清HPS水平均顯著高于對照組(均P0.01)。2.HPS在阻塞性黃疸肝損傷診斷中的曲線下面積達(dá)到0.938,最佳節(jié)點(diǎn)是141.87ng/ml。3.阻塞性黃疸患者血清中HPS與ALT呈正相關(guān),rs=0.914(P0.01)。4.慢性肝病中非衰竭者Child A、Child B、Child C與慢加急性肝衰竭(ACLF)、慢性肝衰竭(CLF)5組之間兩兩比較,非肝衰竭組中,隨著CPC升高,HPS水平也逐漸升高(均P0.05),兩組肝衰竭血清HPS水平均高于非衰竭各組(均P0.05),兩組肝衰竭之間HPS水平差異無統(tǒng)計(jì)學(xué)意義(P=0.58)。結(jié)論:1.阻塞性黃疸肝損傷和慢性肝病患者血清HPS水平升高。2.血清HPS水平測定能夠用于阻塞性黃疸肝損傷的診斷,且具有較高的準(zhǔn)確性和特異性。3.阻塞性黃疸患者血清中HPS與ALT具有較好的正相關(guān)性,綜合HPS本身增殖因子的特性,認(rèn)為其能夠更好地反映肝損傷嚴(yán)重程度。4.慢性肝病患者血清HPS水平隨著病情嚴(yán)重程度的加重而升高,作為一種高特異性血清標(biāo)記物配合CPC有可能對慢性肝病患者肝功能做出更為精確的評估,了解有無惡化趨勢,預(yù)知肝衰竭的發(fā)生;同時(shí)配合肝衰竭診斷標(biāo)準(zhǔn),早期診斷及時(shí)治療,對降低肝衰竭患者并發(fā)癥發(fā)生率和死亡率有重要的臨床意義。
[Abstract]:Aim: to investigate the role of hepatoactive factor (HPS) in the diagnosis of liver injury caused by obstructive jaundice and the assessment of liver function in chronic liver disease. Methods: serum HPS levels were determined by Elisa in 68 patients with chronic liver disease and 30 healthy controls randomly selected from 60 patients with obstructive jaundice. Alanine aminotransferase (alt), total bilirubin (TBILL), plasma albumin (Alb), prothrombin time (PTT) were detected by our laboratory. According to the obtained TBILAL-ALBX PT, the patients with chronic liver failure were divided into eight groups according to the type of failure, including hepatic encephalopathy and ascites, with or without liver failure. There were 13 cases of Child A grade A and 21 cases of Child B grade C in non-hepatic failure, and 11 cases of CLF in 13 cases of liver failure. To analyze the difference of serum HPS level between the two kinds of liver injury patients and normal people, draw the operating characteristic curve of subjects and judge the value of HPS in the diagnosis of liver injury caused by obstructive jaundice by observing the size of AUC. The correlation between serum HPS and ALT in patients with obstructive jaundice and the relationship between HPS and CPC and liver failure in patients with chronic liver disease were analyzed. The result is 1: 1. The serum HPS levels in patients with obstructive jaundice and chronic liver disease were significantly higher than those in the control group (the area under the curve of all P0.01).2.HPS in the diagnosis of obstructive jaundice liver injury was 0.938, the best node was 141.87 ng / ml. 3). There was a positive correlation between serum HPS and ALT in patients with obstructive jaundice. There was a significant difference between Child ACLF C in patients with chronic liver failure and those with chronic and acute liver failure, chronic liver failure and chronic liver failure, in non-hepatic failure group. With the increase of CPC, the serum HPS level of liver failure group was higher than that of non-failure group (P 0.05). There was no significant difference in HPS level between the two groups. Conclusion 1. The serum HPS level in patients with obstructive jaundice liver injury and chronic liver disease was increased. 2. 2. The determination of serum HPS level can be used in the diagnosis of liver injury in obstructive jaundice with high accuracy and specificity. HPS and ALT in serum of patients with obstructive jaundice have good positive correlation. It is considered that HPS can better reflect the severity of liver injury by synthesizing the characteristics of proliferating factor of HPS itself. The level of serum HPS in patients with chronic liver disease increases with the severity of the disease. As a highly specific serum marker combined with CPC, it may be possible to make a more accurate assessment of liver function in patients with chronic liver disease and understand whether there is a trend of deterioration. It is important to predict the occurrence of liver failure and to combine with the diagnostic criteria of liver failure and early diagnosis and treatment to reduce the incidence of complications and mortality in patients with liver failure.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R575

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