本文關(guān)鍵詞： HMGB1 乙型肝炎 肝衰竭 預(yù)后預(yù)測(cè) 中國(guó)評(píng)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(yán)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(dá)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(duì)病情做出及時(shí)判斷,采取合理治療方案。積極探索肝衰竭新的預(yù)警指標(biāo)和早期診斷方法是肝病工作者關(guān)注的重點(diǎn)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(zhǎng)炎癥反應(yīng)。HBV相關(guān)的慢加急性肝衰竭時(shí),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(qiáng),促使機(jī)體的免疫反應(yīng)進(jìn)入激進(jìn)狀態(tài),提示HMGBl可能與肝衰竭的發(fā)病有相關(guān)性。如何準(zhǔn)確評(píng)判肝衰竭患者的預(yù)后是值得探討的臨床課題。 方法1.對(duì)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(jī)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(cè),分析HMGB1表達(dá)與患者肝功能生物化學(xué)指標(biāo)的相關(guān)性。2.根據(jù)我國(guó)乙肝肝衰竭患者特點(diǎn),通過七個(gè)臨床指標(biāo)組成的中國(guó)評(píng)分系統(tǒng)對(duì)70例肝衰竭患者預(yù)后進(jìn)行評(píng)價(jià)。應(yīng)用SPSS17.0統(tǒng)計(jì)軟件包進(jìn)行數(shù)據(jù)處理。計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差表示,兩組均數(shù)間比較采用t檢驗(yàn),率的比較采用χ2檢驗(yàn)。同時(shí)繪制受試者工作特征(ROC)曲線,用c-統(tǒng)計(jì)值(即ROC曲線下面積)評(píng)價(jià)中國(guó)評(píng)分對(duì)乙型病毒性肝炎肝衰竭患者預(yù)后的預(yù)測(cè)準(zhǔn)確性。以期制定一套不同于歐美國(guó)家的評(píng)分標(biāo)準(zhǔn)。 結(jié)果1、患者和正常人血清中均有HMGB1表達(dá),其中重癥肝炎(肝衰竭)組、慢乙肝組、急性乙肝組HMGB1表達(dá)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(jì)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(jì)學(xué)(p0.00)。 2、中國(guó)評(píng)分系統(tǒng)的分值越高,肝衰竭患者的病死率越高。ROC曲線對(duì)中國(guó)評(píng)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(shí)驗(yàn)通過探討HMGB1在肝衰竭患者中的表達(dá)水平及其臨床意義,為臨床診斷提供新的依據(jù)；針對(duì)乙型肝炎肝衰竭的特殊性,通過七個(gè)臨床指標(biāo)組成的中國(guó)評(píng)分系統(tǒng)對(duì)我國(guó)乙肝肝衰竭患者的預(yù)后評(píng)價(jià)是可行的。綜上所述,HMGB1和中國(guó)評(píng)分系統(tǒng)對(duì)乙型肝炎引起的肝衰竭患者預(yù)后預(yù)測(cè)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，

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