本文選題：APRI　切入點(diǎn)：肝纖維化　出處：《安徽醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的： 評(píng)價(jià)血清天冬氨酸轉(zhuǎn)氨酶（AST）與血小板（PTL）比值（APRI），在判斷丙氨酸氨基轉(zhuǎn)移酶及天冬氨酸轉(zhuǎn)氨酶（AST及ALT）均在正常檢測范圍上限（40U/L）2倍以下的慢性乙型肝炎病毒（HBV）感染患者肝臟纖維化程度中的作用,發(fā)現(xiàn)潛在抗病毒對(duì)象并指導(dǎo)臨床抗病毒治療。 方法: 選擇2010-2011年在安徽醫(yī)科大學(xué)第一附屬醫(yī)院感染病科住院行肝組織病理學(xué)檢查的349例臨床診斷慢性HBV感染患者，且肝臟穿刺檢查前一周內(nèi)行肝功能檢查，丙氨酸氨基轉(zhuǎn)移酶、天冬氨酸轉(zhuǎn)氨酶均小于2倍正常檢測范圍上限值（即小于80U/L）。完善常規(guī)實(shí)驗(yàn)室檢查，如血常規(guī)、乙肝五項(xiàng)定量（雅培）、乙肝病毒定量檢測等和肝臟活組織檢查,計(jì)算出APRI，比較不同的肝臟纖維化程度與APRI指數(shù)的關(guān)系。應(yīng)用受試者工作特征（ROC）曲線評(píng)價(jià)APRI模型在評(píng)估肝臟纖維化程度中的臨床診斷及應(yīng)用價(jià)值，采用Spearman等級(jí)相關(guān)分析判斷APRI與肝臟纖維化病理分期的相關(guān)性。 研究結(jié)果： 1.符合標(biāo)準(zhǔn)的慢性乙性肝炎病毒感者349例，， HBV DNA陽性297例,占85.1%，血清HBeAg陽性196例，占56.2%。根據(jù)肝纖維化分期：S0期21例，S1期123例，S2期96例，S3期58例，S4期51例。以S2以上為顯著肝纖維化。當(dāng)APRI≥0.273時(shí)，患者有顯著肝纖維化，ROC曲線下面積為0.641,靈敏度為48.3%，特異度為75.7%，陽性預(yù)測值為73.9%(P=0.0001)；APRI≥0.311時(shí)，患者為肝硬化，ROC曲線下面積為0.771,靈敏度為68.6%,特異度為76.8%,陰性預(yù)測值為93.5%(P=0.0001)。 2.在HBV DNA為1×103~1×105拷貝/mL組中，APRI≥0.179為明顯肝纖維化最優(yōu)截點(diǎn)，APRI≥0.283為肝硬化最優(yōu)截點(diǎn)；在HBV DNA為1×106~1×108拷貝/mL組中，APRI≥0.275為明顯肝纖維化最優(yōu)截點(diǎn)，APRI≥0.326為肝硬化最優(yōu)截點(diǎn)。 3． HBeAg陽性的慢性乙型肝炎病毒感染的病例中，APRI≥0.283為明顯肝纖維化最優(yōu)截點(diǎn)，APRI≥0.287為肝硬化最優(yōu)截點(diǎn)； HBeAg陰性的慢性乙性肝炎病毒感染的病例中，APRI≥0.179為明顯肝纖維化最優(yōu)截點(diǎn)，APRI≥0.349為肝硬化最優(yōu)截點(diǎn)， 4．在297例HBV DNA陽性病例中，APRI≥0.273為明顯肝纖維化最優(yōu)截點(diǎn)，APRI≥0.311為肝硬化最優(yōu)截點(diǎn)；在52例HBV DNA陰性病例中，APRI≥0.153為明顯肝纖維化最優(yōu)截點(diǎn)，APRI≥0.258為肝硬化最優(yōu)截點(diǎn)。 5.Spearman相關(guān)分析顯示， APRI與肝纖維化分期呈顯著正相關(guān)性（r=0.370,P0.001）。 結(jié)論： APRI可用于丙氨酸氨基轉(zhuǎn)移酶及天冬氨酸轉(zhuǎn)氨酶均在正常值上限2倍以下的慢性HBV感染患者肝纖維化程度的判斷,APRI≥0.273時(shí)為有明顯肝纖維化(纖維化病理分級(jí)在S2及以上),73.9%符合病理分級(jí)，對(duì)臨床選擇抗病毒治療的時(shí)機(jī)具有一定指導(dǎo)意義。若APRI指數(shù)不超過0.311，則93.5%的轉(zhuǎn)氨酶正常值上限2倍以下的慢性乙性肝炎病毒感染者可排除已進(jìn)展為肝炎肝硬化。根據(jù)HBV-DNA水平不同,制定相應(yīng)的APRI指數(shù)評(píng)價(jià)肝纖維化程度,可提高臨床應(yīng)用價(jià)值。
[Abstract]:Objective:. To evaluate the ratio of serum aspartate aminotransferase (AST) to platelets (PTL) and to determine whether alanine aminotransferase, aspartate aminotransferase (AST) and alt are in the upper limit of the normal detection range of chronic hepatitis B virus hepatitis B virus (HBV) infection which is less than 40 U / L ~ (2) times. The role of liver fibrosis, Identify potential antiviral objects and guide clinical antiviral therapy. Methods:. A total of 349 patients with chronic HBV infection were enrolled in the Department of Infectious Diseases, first affiliated Hospital of Anhui Medical University from 2010 to 2011. Liver function examination and alanine aminotransferase were performed within one week before liver puncture examination. Aspartate aminotransferase is less than 2 times the upper limit of normal detection range (that is, less than 80 U / L). Perfect routine laboratory examination, such as blood routine, hepatitis B five quantitative (Abbott, hepatitis B virus quantitative detection and liver biopsy, etc.). The relationship between the degree of hepatic fibrosis and the APRI index was compared. The clinical diagnosis and application value of APRI model in evaluating the degree of hepatic fibrosis were evaluated by using the operating characteristics of the subjects. Spearman grade correlation analysis was used to determine the correlation between APRI and pathological stage of liver fibrosis. Results of the study:. 1. In 349 cases of chronic hepatitis B virus, 297 cases (85.1%) were positive for HBV DNA, and 196 cases were positive for serum HBeAg. According to the stage of hepatic fibrosis, there were 21 cases of stage S 1, 123 cases of S 2 stage, 96 cases of S 3 stage and 58 cases of S 4 stage 51 cases. The liver fibrosis was more than S2. When APRI 鈮

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