本文選題：克羅恩病 + 潰瘍性結(jié)腸炎��； 參考：《浙江大學(xué)》2013年博士論文

【摘要】：目的： 在臨床實(shí)踐中,潰瘍性結(jié)腸炎(UC)和克羅恩病(CD)的鑒別十分重要,然而常常由于臨床表現(xiàn)不典型、模棱兩可的內(nèi)鏡檢查結(jié)果和影像表現(xiàn)以及腸鏡下活檢的深度不夠,使得鑒別UC和CD成為一個(gè)難題。IBD的診斷指標(biāo)包括一些生物學(xué)標(biāo)記,本研究將相互獨(dú)立的血清標(biāo)記物作為參數(shù)進(jìn)行整合,通過統(tǒng)計(jì)學(xué)工具和方法構(gòu)建了一個(gè)用于鑒別僅結(jié)腸損傷的UC和CD的診斷模型,并進(jìn)一步檢驗(yàn)該診斷模型的效能。 并通過meta分析探討克羅恩病(CD)與腸結(jié)核(ITB)內(nèi)鏡表現(xiàn)和組織病理學(xué)特征,為兩者的鑒別診斷提供依據(jù)。 研究對(duì)象及方法： 2006年2月至2011年2月,采用回顧性分析的方法,收集了來自浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院的140名UC住院患者和174名CD住院患者的資料。首次住院治療的這段時(shí)間收集周圍靜脈血液樣本,根據(jù)所測(cè)的血清標(biāo)記物的結(jié)果,我們構(gòu)建了兩個(gè)邏輯回歸模型。為了評(píng)估最終擬合模型的有效性,我們還用了受試者工作特征(ROC)來評(píng)估該診斷模型的預(yù)測(cè)效果,ROC曲線下面積(AUC)用來評(píng)估其準(zhǔn)確度。 檢索Pubmed、EBSCO、Web of science、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(the Cochrane Library and Chinese Biomedicine Database)、維普、萬方數(shù)據(jù)庫等數(shù)據(jù)庫,時(shí)間1995年1月到2013年6月發(fā)表的關(guān)于克羅恩病和腸結(jié)核內(nèi)鏡表現(xiàn)和組織病理學(xué)特征的文獻(xiàn),由2名評(píng)價(jià)員獨(dú)立采用QUADAS(Quality Assessment of Diagnostic AccuracyStudies)工具進(jìn)行質(zhì)量評(píng)價(jià),應(yīng)用Meta-disc1.4和stata12.0做異質(zhì)性檢驗(yàn),根據(jù)異質(zhì)性檢驗(yàn)結(jié)果選擇相應(yīng)的效應(yīng)模型合并,評(píng)價(jià)其敏感性、特異性、似然比和診斷比值比,描繪SROC曲線并計(jì)算曲線下面積,對(duì)于研究間存在較高異質(zhì)性,用Meta回歸分析找異質(zhì)性來源,并做敏感性分析。 結(jié)果： 我們利用BIC來挑選出與疾病狀態(tài)相關(guān)的預(yù)測(cè)變量。在無效模型中,利用BIC選出了預(yù)測(cè)變量Alb,TC,Plt以及Alb:Plt.在備擇模型中,同樣的方法選出了新的預(yù)測(cè)變量GPDA以及另加的傳統(tǒng)預(yù)測(cè)變量TCa,兩兩相互作用項(xiàng)Alb:Plt,Alb:GPDA, TCa:TC和Plt:GPDA.CD/UC指數(shù)(CUI)結(jié)果為CUl=1.901+0.425Alb-3.324TC一7.444TCa+0.018Plt+0.087GPDA-0.0007Alb:Plt-0.004Alb:GPDA+1.839TC:TCa+0.003Plt:GPDA。UC患者的CUI大于CD患者的,CUI0則遞增性傾向于UC的診斷,而CUI0則對(duì)應(yīng)CD診斷的可能性更高。無效模型和備擇模型的AUCs的平均值分別為0.66(95%置信區(qū)間：0.59-0.72)和0.73(95%置信區(qū)間：0.67-0.80)。截?cái)帱c(diǎn)對(duì)應(yīng)的靈敏度和特異度,備擇模型中分別為0.55和0.80,而無效模型中分別為0.46和0.79。 meta分析共納入15篇文獻(xiàn),包括1271個(gè)研究對(duì)象,其中克羅恩病671個(gè),腸結(jié)核600個(gè)。統(tǒng)計(jì)結(jié)果顯示：以克羅恩病為陽性對(duì)照,其敏感性、特異性、陽性似然比、陰性似然比、診斷比值比和SROC曲線下面積分別為：阿弗他潰瘍0.39,0.80,2.20,0.75,3.34,0.7252；腸腔狹窄0.35,0.72,1.37,0.89,1.54,0.4626；鵝卵石征0.28,0.96,5.25,0.79,7.05,0.6212；跳躍征0.61,0.57,1.52,0.71,2.52,為0.6420；縱形潰瘍0.42,0.94,6.18,0.65,11.02,0.7898；微肉芽腫0.42,0.69,1.42,0.82,2.08,0.5768。而以腸結(jié)核為陽性對(duì)照,環(huán)形潰瘍0.43,0.88,3.66,0.64,7.07,0.7515；回盲部擴(kuò)張0.38,0.91,3.98,0.74,5.98,0.8404；干酪樣壞死0.42,1.00,17.10,0.69,38.25,0.9976；肉芽腫0.73,0.63,1.78,0.50,4.83,0.7268；融合肉芽腫0.41,0.99,17.74,0.60,29.86,0.9705；每個(gè)切片肉芽腫大于5個(gè)0.26,0.94,4.45,0.80,5.52,0.5702；粘膜下肉芽腫0.30,0.90,2.92,0.76,4.00,0.6559；不成比例的粘膜下炎癥0.52,0.75,2.84,0.59,4.52,0.6679；肉芽組織0.31,0.92,3.68,0.72,5.23,0.8723；ulcers lined by histiocyte0.42,0.95,6.33,0.55,12.52,0.9248。 結(jié)論： 根據(jù)血清標(biāo)記物的檢測(cè)結(jié)果構(gòu)建的CUI可成為克羅恩病和潰瘍性結(jié)腸炎的鑒別診斷的輔助工具,特別是在臨床病史不明,內(nèi)鏡和影像學(xué)特征異常,活組織檢查模棱兩可的情況下。 診斷性meta分析結(jié)果提示阿弗他潰瘍、腸腔狹窄、鵝卵石征、跳躍征、縱形潰瘍、微肉芽腫有助于診斷克羅恩病,而同時(shí)環(huán)形潰瘍、回盲部擴(kuò)張、干酪樣壞死、肉芽腫、融合肉芽腫、每個(gè)切片肉芽腫大于5個(gè)、粘膜下肉芽腫、不成比例的粘膜下炎癥和肉芽組織有助于診斷腸結(jié)核。因此,內(nèi)鏡結(jié)合病例組織活檢的特異性表現(xiàn)對(duì)于鑒別克羅恩病和腸結(jié)核意義重大。
[Abstract]:Objective:
In clinical practice, the identification of ulcerative colitis (UC) and Crohn's disease (CD) is very important. However, it is often due to untypical clinical manifestations, ambiguous endoscopic findings and imaging findings, and the insufficient depth of endoscopic biopsy, making the identification of UC and CD a difficult problem of.IBD, including some biological markers, this study According to the integration of independent serum markers as parameters, a diagnostic model for identifying UC and CD for colonic damage only was constructed by statistical tools and methods, and the effectiveness of the diagnostic model was further tested.
The endoscopic and histopathological features of Crohn's disease (CD) and intestinal tuberculosis (ITB) were studied by meta analysis.
Research objects and methods:
From February 2006 to February 2011, a retrospective analysis was used to collect data from 140 UC inpatients and 174 CD inpatients from the First Affiliated Hospital of Zhejiang University medical college. The first hospitalization period collected peripheral blood samples. According to the results of the blood serum markers, we constructed two logic. Regression model. In order to evaluate the effectiveness of the final fitting model, we also used the ROC to evaluate the predictive effect of the model, and the area under the ROC curve (AUC) was used to evaluate its accuracy.
Pubmed, EBSCO, Web of science, Chinese biomedical literature database (the Cochrane Library and Chinese Biomedicine Database), VP, Wanfang database, and other databases on the features of Crohn's disease and intestinal tuberculosis endoscopes and histopathology published in January 1995 to June 2013, were independently collected by 2 evaluators. Using the QUADAS (Quality Assessment of Diagnostic AccuracyStudies) tool for quality evaluation, using Meta-disc1.4 and stata12.0 to do heterogeneity test, select the corresponding effect model combination according to the heterogeneity test results, evaluate its sensitivity, specificity, likelihood ratio and diagnostic ratio ratio, depict the SROC curve and calculate the area under the curve, There is a high heterogeneity between the studies, and Meta regression analysis is used to find the source of heterogeneity and make sensitivity analysis.
Result錛，

本文編號(hào)：1851370