本文關(guān)鍵詞： HMGB1 乙型肝炎 肝衰竭 預(yù)后預(yù)測 中國評分系統(tǒng)　出處：《新鄉(xiāng)醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的乙型肝炎病毒感染是全球性的公共衛(wèi)生問題,嚴重威脅人類生命健康。全球約有3.5億人是慢性感染者,全球每年約有70萬人死于HBV相關(guān)的終末期肝病,如肝衰竭、失代償期肝硬化等。終末期肝病的死亡率高達70%以上,肝衰竭以慢性肝衰竭急性發(fā)作占多數(shù),此類患者病情發(fā)展迅速,在患者住院早期需臨床醫(yī)生對病情做出及時判斷,采取合理治療方案。積極探索肝衰竭新的預(yù)警指標和早期診斷方法是肝病工作者關(guān)注的重點課題之一。研究表明,HMGB1作為晚期炎性因子,參與膿毒癥和SIRS的病理生理過程,維持和延長炎癥反應(yīng)。HBV相關(guān)的慢加急性肝衰竭時,血循環(huán)中的DC富集到肝臟,并被激活后,抗原遞呈作用明顯加強,促使機體的免疫反應(yīng)進入激進狀態(tài),提示HMGBl可能與肝衰竭的發(fā)病有相關(guān)性。如何準確評判肝衰竭患者的預(yù)后是值得探討的臨床課題。 方法1.對32例乙型重癥肝炎患者、22例慢乙肝患者、10例急性乙肝患者及16例健康體檢者于肘靜脈處抽取靜脈血,于抽血后30分鐘內(nèi)置離心機離心分離出血清分裝至1.5ml的離心管中置于-80℃冰箱保存待用ELISA檢測,分析HMGB1表達與患者肝功能生物化學(xué)指標的相關(guān)性。2.根據(jù)我國乙肝肝衰竭患者特點,通過七個臨床指標組成的中國評分系統(tǒng)對70例肝衰竭患者預(yù)后進行評價。應(yīng)用SPSS17.0統(tǒng)計軟件包進行數(shù)據(jù)處理。計量資料用均數(shù)±標準差表示,兩組均數(shù)間比較采用t檢驗,率的比較采用χ2檢驗。同時繪制受試者工作特征(ROC)曲線,用c-統(tǒng)計值(即ROC曲線下面積)評價中國評分對乙型病毒性肝炎肝衰竭患者預(yù)后的預(yù)測準確性。以期制定一套不同于歐美國家的評分標準。 結(jié)果1、患者和正常人血清中均有HMGB1表達,其中重癥肝炎(肝衰竭)組、慢乙肝組、急性乙肝組HMGB1表達水平均高于正常人組；組間比較顯示：重癥肝炎組與慢乙肝初治,重癥肝炎組與急性乙肝組,慢乙肝初治組與急性乙肝組,慢性乙肝組與正常人組,急性乙肝—正常人組均無統(tǒng)計學(xué)意義(p0.05),其中重癥肝炎組與正常人組組間差異有統(tǒng)計學(xué)(p0.00)。 2、中國評分系統(tǒng)的分值越高,肝衰竭患者的病死率越高。ROC曲線對中國評分系統(tǒng)判斷肝衰竭患者預(yù)后的ROC曲線下面積0.877,用該模型判斷70例重型肝炎患者預(yù)后是可信的。 結(jié)論本實驗通過探討HMGB1在肝衰竭患者中的表達水平及其臨床意義,為臨床診斷提供新的依據(jù)；針對乙型肝炎肝衰竭的特殊性,通過七個臨床指標組成的中國評分系統(tǒng)對我國乙肝肝衰竭患者的預(yù)后評價是可行的。綜上所述,HMGB1和中國評分系統(tǒng)對乙型肝炎引起的肝衰竭患者預(yù)后預(yù)測是有指導(dǎo)意義的。
[Abstract]:Objective Hepatitis B virus infection is a global public health problem, which is a serious threat to human life and health. About 350 million people in the world are chronically infected, and every year about 700,000 people die of HBV related end-stage liver disease, such as liver failure. Decompensated liver cirrhosis and so on. The death rate of end-stage liver disease is as high as more than 70%. The majority of liver failure is acute attack of chronic liver failure. This kind of patient's condition develops rapidly. In the early stage of hospitalization, clinicians are required to make timely judgement on the condition of the patient. It is one of the most important topics for liver disease workers to adopt reasonable treatment plan and actively explore new early warning index and early diagnosis method of liver failure. The study shows that HMGB1, as a late inflammatory factor, is involved in the pathophysiological process of sepsis and SIRS. When chronic and acute hepatic failure associated with HBV was maintained and prolonged, DC in the blood circulation was enriched into the liver, and after activation, the antigen presentation was significantly enhanced, and the immune response of the body entered into a radical state. It is suggested that HMGBl may be associated with the pathogenesis of liver failure, and how to accurately evaluate the prognosis of patients with liver failure is a clinical topic worthy of discussion. Methods 1. Venous blood was drawn from the cubital vein of 32 patients with severe hepatitis B, 22 patients with chronic hepatitis B and 10 patients with acute hepatitis B and 16 healthy controls. After 30 minutes of blood sampling, centrifuge centrifuge was used to separate the serum and put it into 1.5ml centrifuge tube. The serum was stored in the refrigerator at -80 鈩，

本文編號：1535445