本文選題：D二聚體　切入點(diǎn)：纖維蛋白原　出處：《濱州醫(yī)學(xué)院》2013年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的 探討乙肝肝硬化患者血清D二聚體(D-D)和血漿纖維蛋白原(FIB)的變化情況及臨床意義；研究臍帶間充質(zhì)干細(xì)胞(UCMSC)治療失代償期乙肝肝硬化的早期療效。 方法 第一部分：以乙肝肝硬化患者73例(Child A級(jí)27例,Child B級(jí)26例,ChildC級(jí)20例)為研究對(duì)象,同期健康體檢者24例為對(duì)照組；分別檢測(cè)其血清D-D、血漿FIB水平。比較兩組D-D和FIB水平的差異及不同Child分級(jí)肝硬化患者D-D和FIB水平的差異。評(píng)價(jià)二者對(duì)乙肝肝硬化患者肝臟功能損傷程度的診斷價(jià)值。 第二部分：研究納入失代償期乙肝肝硬化患者45例,所有患者均予內(nèi)科綜合治療,其中行UCMSC治療的19例為治療組,未行UCMSC治療的26例為對(duì)照組。通過(guò)比較兩組患者第1,2,4,8,12周總膽紅素(TBiL)下降值、白蛋白(Alb)升高值、PTA改善值來(lái)評(píng)價(jià)其早期療效；通過(guò)生存曲線比較兩組患者并發(fā)癥的發(fā)生差異。 結(jié)果 1、乙肝肝硬化組血清D-D和血漿FIB含量與正常對(duì)照組比較,差異均有統(tǒng)計(jì)學(xué)意義。乙肝肝硬化組Child三級(jí)之間血清D-D均有統(tǒng)計(jì)學(xué)差異；FIB含量Child A級(jí)、B級(jí)無(wú)統(tǒng)計(jì)學(xué)差異,Child A級(jí)、B級(jí)與Child C級(jí)有統(tǒng)計(jì)學(xué)差異。 2、治療組和對(duì)照組兩組Alb、PTA水平均較基線水平升高,TBiL水平均較基線水平下降；治療組Alb升高值、PTA改善值、TBiL下降值均優(yōu)于對(duì)照組；隨訪12周時(shí),治療組Child C級(jí)患者所占比例低于對(duì)照組；生存曲線提示,治療組患者腹水、肝性腦病等陽(yáng)性事件的累積發(fā)生率低于對(duì)照組,P=0.043。 結(jié)論 1、血清D-D和血漿FIB水平與肝臟的損傷程度密切相關(guān),檢測(cè)二者水平有助于評(píng)估乙肝肝硬化患者的病情嚴(yán)重程度及指導(dǎo)治療。 2、UCMSC治療失代償期乙肝肝硬化早期療效較好,遠(yuǎn)期療效需進(jìn)一步觀察。
[Abstract]:Purpose. To investigate the changes and clinical significance of serum D dimer D-D) and plasma fibrinogen (FB) in patients with hepatitis B cirrhosis, and to study the early therapeutic effect of UCM SCC on decompensated hepatitis B cirrhosis. Method. The first part: 73 patients with hepatitis B cirrhosis, 27 patients with Child B grade B and 20 patients with Child B grade C) were studied, and 24 healthy persons were taken as the control group in the same period. The serum D-D and plasma FIB levels were measured, the difference of D-D and FIB levels between the two groups and D-D and FIB levels in patients with liver cirrhosis with different Child grades were compared, and the diagnostic value of D-D and FIB in patients with hepatitis B cirrhosis was evaluated. The second part: the study included 45 patients with decompensated hepatitis B cirrhosis, all of whom were given comprehensive medical treatment, 19 of whom were treated with UCMSC as the treatment group. 26 cases without UCMSC were treated as control group. The early curative effect was evaluated by comparing the decreasing value of total bilirubin and the elevation of albumin Alb and the difference of complications between the two groups by survival curve. Results. 1. The levels of serum D-D and plasma FIB in patients with hepatitis B cirrhosis were compared with those in normal controls. There was no statistical difference in serum D-D content between three levels of Child in patients with hepatitis B cirrhosis. There was no statistical difference in serum D-D content between Child A class and B grade. There was statistical difference between Child C and Child A grade. 2. The levels of Alb in the treatment group and the control group were both higher than the baseline level and lower than the baseline level, and the improvement value of Alb in the treatment group was higher than that in the control group. At 12 weeks follow-up, the improvement value of Alb in the treatment group was higher than that in the control group. The survival curve indicated that the cumulative incidence of ascites and hepatic encephalopathy in the treatment group was lower than that in the control group. Conclusion. 1. The levels of serum D-D and plasma FIB were closely related to the degree of liver injury. 2 the early efficacy of UCMSC in the treatment of decompensated hepatitis B cirrhosis needs further observation.
【學(xué)位授予單位】：濱州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R575.2;R512.62

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