【摘要】：目的：建立聚乙二醇干擾素α治療HBeAg陽性慢性乙型肝炎血清學(xué)轉(zhuǎn)換的預(yù)測模型并驗證其預(yù)測價值。方法：連續(xù)收集自本中心確診為HBeAg陽性CHB患者的基線、第12周、16周、24周和48周相關(guān)血清學(xué)指標(biāo)。將病例隨機分為建模組和驗證組。在建模組中，對建模組的各因素與HBeAg血清學(xué)轉(zhuǎn)換的顯著性關(guān)系進行單因素分析，把有顯著性關(guān)系的預(yù)測因素用二元logistic回歸分析驗證HBeAg血清學(xué)轉(zhuǎn)換的獨立預(yù)測因素。選取獨立預(yù)測因素及回歸系數(shù)建立預(yù)測模型。采取約登指數(shù)值最大為最佳臨界點以區(qū)分是否在48周內(nèi)發(fā)生HBeAg血清學(xué)轉(zhuǎn)換。在驗證組中用受試者工作曲線（ROC曲線）分析方法驗證模型的診斷價值。結(jié)果：共有129例CHB患者納入本研究。隨機抽取90例作為建模組，其余39例作為驗證組。對各預(yù)測因素與發(fā)生HBeAg血清學(xué)轉(zhuǎn)換進行單因素分析，結(jié)果顯示，基線HBV-DNA（P=0.017）、HBeAg12（P0.001）、HBV-DNA12（P=0.007）、HBeAg16（P0.001）、HBV-DNA16（P=0.034）、HBeAg24（P0.001）、HBV-DNA24（P=0.010）、S/D（P=0.037）、S/D12（P=0.007）、S/D24（P=0.044）、ΔE24/HBeAg （P=0.001）均與發(fā)生HBeAg血清學(xué)轉(zhuǎn)換存在相關(guān)性。應(yīng)用二元Logistic回歸分析法分析相關(guān)指標(biāo)，得出HBeAg16（P=0.009）、HBeAg24(P0.001)為獨立預(yù)測因素。構(gòu)建一個HBeAg血清學(xué)轉(zhuǎn)換預(yù)測的模型S：S=0.806+0.659ln（HBeAg16）-1.297ln（HBeAg24）。把預(yù)測模型運用于驗證組HBeAg血清學(xué)轉(zhuǎn)換預(yù)測通過ROC曲線進行分析，得出AUC為0.873，95%可信區(qū)間為0.764~0.983。取約登指數(shù)最大值為預(yù)測的最佳臨界值（S=-0.917），根據(jù)這個臨界值進行預(yù)測，敏感性為100%，特異性為67.9%，陽性預(yù)測值為55.0%，陰性預(yù)測值為100%。結(jié)論：由第16周和第24周HBeAg水平構(gòu)建的預(yù)測模型對PegIFNα治療HBeAg陽性CHB患者血清學(xué)轉(zhuǎn)換率有較好的預(yù)測準(zhǔn)確性。
[Abstract]:Objective: To establish a predictive model for seroconversion of HBeAg-positive chronic hepatitis B and to verify its predictive value. Methods: The baseline, 12-week, 16-week, 24-week and 48-week serological markers of HBeAg-positive CHB patients were collected. The cases were randomly divided into the modeling group and the verification group. In the module under construction, the single-factor analysis of the relationship between the factors of the modeling group and the seroconversion of HBeAg was carried out, and the independent prediction factors of the seroconversion of HBeAg were verified by the binary logistic regression analysis. and the independent prediction factors and the regression coefficients are selected to establish a prediction model. The most preferred critical point was taken to distinguish whether HBeAg seroconversion occurred within 48 weeks. The diagnostic value of the model was verified by the subject's work curve (ROC curve) in the validation group. Results: A total of 129 CHB patients were included in this study. 90 cases were randomly selected as the modeling group and the remaining 39 cases were used as the verification group. The results showed that the HBV-DNA (P = 0.017), BAg12 (P0.001), HBV-DN12 (P = 0.7), AAg16 (P0.001), HBV-DN16 (P = 0.034), AAg24 (P0.001), HBV-DN24 (P = 0. 010), S/ D (P = 0.037), S/ D12 (P = 0. 007), S/ D24 (P = 0.044), AE24/ HBeAg (P = 0. 001) were all related to the seroconversion of HBeAg. The correlation index was analyzed by the two-way logistic regression analysis method, and the independent predictors were obtained from the AAg16 (P = 0. 009) and the AAg24 (P0.001). A model S: S = 0.806 + 0.659ln (SupAg16)-1.297ln (SupAg24) for HBeAg seroconversion prediction was constructed. The prediction model was used in the seroconversion prediction of HBeAg in the validation group, and the ROC curve was analyzed to obtain the AUC of 0.873 and the confidence interval of 95% was 0.764-0.9883. The predicted optimal threshold (S =-0.917) was used to predict the maximum value of the denden index (S =-0.917). The sensitivity was 100%, the specificity was 6.7. 9%, the positive predictive value was 55. 0%, and the negative predictive value was 100%. Conclusion: The predictive model constructed by the levels of HBeAg at week 16 and week 24 has good predictive accuracy for the seroconversion rate of PegIFN-treated HBeAg-positive CHB patients.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R512.62

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 夏吉榮;鄒麟;周春燕;向渝;張莉萍;;i2000化學(xué)發(fā)光儀檢測HBsAg適用稀釋液及最適稀釋倍數(shù)的選擇[J];重慶醫(yī)學(xué);2010年24期

2 李衛(wèi);李銘;李永華;李旭;;聚乙二醇干擾素α-2a治療慢性乙型肝炎的療效分析[J];實用肝臟病雜志;2010年06期

3 ;慢性乙型肝炎防治指南(2010年版)[J];實用肝臟病雜志;2011年02期

4 陳靖;鄭琦;江家驥;鄭佳萍;;聚乙二醇干擾素α-2a治療HBeAg陽性慢性乙型肝炎療效的影響因素分析[J];中南大學(xué)學(xué)報(醫(yī)學(xué)版);2012年07期

5 梁東;羅紅濤;鐘銳興;;聚乙二醇干擾素α-2a治療慢性乙型肝炎的療效及HBeAg血清轉(zhuǎn)換的相關(guān)因素[J];實用醫(yī)學(xué)雜志;2010年15期

6 趙文海;曾凡榮;韋玉芳;劉麗;陳東升;;乙型肝炎病毒B和C基因型與干擾素a-2b治療48周效應(yīng)關(guān)系的研究[J];新疆醫(yī)科大學(xué)學(xué)報;2007年09期

7 ;Precise prediction model and simplified scoring system for sustained combined response to interferon-α[J];World Journal of Gastroenterology;2010年27期

8 吳海清;趙鋼德;錢方興;賴榮陶;謝敬東;周惠娟;許潔;徐玉敏;劉柯慧;謝青;王暉;;IL28B基因多態(tài)性與HBeAg陽性慢性乙型肝炎患者聚乙二醇化干擾素α應(yīng)答的關(guān)系[J];肝臟;2013年06期

9 張占卿;陸偉;王雁冰;周新蘭;黃丹;丁榮蓉;沈芳;馮艷玲;;血清HBsAg和HBV DNA對慢性乙型肝炎肝組織病理狀態(tài)的判別評價[J];中華臨床醫(yī)師雜志(電子版);2013年15期

10 朱月永;董菁;陳攸濤;陳靖;江家驥;;e抗原定量對聚乙二醇干擾素治療HBeAg陽性慢性乙型肝炎e抗原血清學(xué)轉(zhuǎn)換的預(yù)測[J];胃腸病學(xué)和肝病學(xué)雜志;2010年10期

，

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