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  本文關鍵詞： 無創(chuàng)診斷 FibrScan APRI FIB-4 潛變量 診斷評價　出處：《中南大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的：乙肝肝硬化的診斷方法較多,尤其是無創(chuàng)診斷方法開展廣泛。在臨床應用和實踐前,我們需對這些方法進行診斷評價,了解其診斷效能及應用范圍。由于肝穿刺活檢無法達到金標準的要求,既往以其為參考標準的診斷評價是不完美和有缺陷的。本研究旨在無金標準診斷方法做參考時,利用潛變量模型對幾種無創(chuàng)診斷方法進行評價。 方法：2013年6月～2014年3月間,對某三甲醫(yī)院肝病科門診的慢性病毒性乙型肝炎患者的臨床數(shù)據(jù)進行收集。利用FibroScan, APRI,FIB-4和白球比四種無創(chuàng)診斷方法對納入的575名患者進行肝硬化或肝纖維的診斷。以上臨床數(shù)據(jù)和診斷評價結局為基礎,用潛變量模型方法對其進行診斷評價,了解各診斷方法的診斷效能及特點。 結果：隨機效應的潛變量模型對本研究臨床數(shù)據(jù)有較好的相適性,可以評價各診斷方法的的效能。診斷乙肝相關性進展期肝纖維化：APRI的特異性和敏感性分別是：99.41%和28.45%；FIB-4的特異性和敏感性分別是：99.35%和98.79%；FibroScan的特異性和敏感性分別是83.42%和55.9%。診斷乙肝相關性肝硬化：APRI的特異性和敏感性分別是：99.99%和19.32%；FIB-4的特異性和敏感性分別是：99.78%和90.23%；FibroSa的特異性和敏感性分別是93.31%和36.81%；白球比的特異性和敏感性分別是99.47%和3.4% 結論：隨機效應潛變量模型在無金標準的前提下,對幾種無創(chuàng)診斷方法的準確性進行評估,FIB-4和FibScan表現(xiàn)出較好的診斷價值。
[Abstract]:Objective: there are many diagnostic methods for hepatitis B cirrhosis, especially non-invasive diagnostic methods are widely used. Before clinical application and practice, we need to evaluate these methods. To understand its diagnostic efficacy and scope of application. Liver biopsy can not meet the requirements of gold standards. This study aims to evaluate several non-invasive diagnostic methods by using latent variable model as a reference. Methods: from June 2013 to March 2014, the clinical data of patients with chronic viral hepatitis B (CHB) in the Department of Hepatology of a third Grade A Hospital were collected and FibroScan was used. APRII-FIB-4 and white-ball ratio four noninvasive diagnostic methods were used to diagnose liver cirrhosis or hepatic fiber in 575 patients. The above clinical data and diagnostic evaluation results were based on the above clinical data. The latent variable model method is used to evaluate the diagnostic efficacy and characteristics of each diagnostic method. Results: the latent variable model of random effect has good compatibility to the clinical data of this study. The specificity and sensitivity of diagnosing Hepatitis B related advanced hepatic fibrosis: 1. The specificity and sensitivity were 99.41% and 28.45%, respectively. The specificity and sensitivity of FIB-4 were 99.35% and 98.79%, respectively. The specificity and sensitivity of FibroScan were 83.42% and 55.9, respectively. 99.99% and 19.32; The specificity and sensitivity of FIB-4 were 99.78% and 90.23%, respectively. The specificity and sensitivity of FibroSa were 93.31% and 36.81 respectively. The specificity and sensitivity of the white ball ratio were 99.47% and 3.4%, respectively. Conclusion: on the premise of no gold standard, the stochastic effect latent variable model can evaluate the accuracy of several noninvasive diagnostic methods. FIB-4 and FibScan have good diagnostic value.
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R512.62

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本文編號：1466401