本文選題：重癥化　切入點(diǎn)：慢性乙型肝炎　出處：《遵義醫(yī)學(xué)院》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:建立并驗(yàn)證重癥化慢性乙型肝炎(chronic hepatitis B,CHB)患者進(jìn)展為慢加急性肝衰竭(acute on chronic liver failure,ACLF)的預(yù)警模型。方法:回顧性分析2011年1月至2017年2月遵義醫(yī)學(xué)院附屬醫(yī)院感染科住院部收治的474例重癥化慢性乙肝患者臨床資料;隨機(jī)將252例患者分為建模組,另外222例患者為驗(yàn)證組。單因素分析找出進(jìn)展為ACLF的危險(xiǎn)因素,進(jìn)一步用Logistic回歸法進(jìn)行多因素分析找出獨(dú)立危險(xiǎn)因素,建立預(yù)警模型;用受試者工作特征(receiver operating characteristic,ROC)曲線及曲線下面積(area under the curve,AUC)評(píng)估預(yù)警模型并與終末期肝病(model for end-stage liver disease,MELD)、MELD-Na模型進(jìn)行比較。結(jié)果:1.共篩選出符合納入及排出標(biāo)準(zhǔn)的重癥化CHB患者474例,其中男399例,女75例;發(fā)展為ACLF 36例,男28例,女8例,平均年齡43.33±10.29歲,未進(jìn)展為ACLF患者438例,男371例,女67例,平均年齡37.68±11.26歲;2.單因素分析發(fā)現(xiàn)HBV DNA、谷氨酰轉(zhuǎn)肽酶(gamma-glutamyl transpeptidase,GGT)、膽堿酯酶(cholinesterase,CHE)、血清總膽紅素(total bilirubin,TBIL)、間接膽紅素(indirect bilirubin,IBIL)、前白蛋白(prealbumin,PA)、凝血酶原時(shí)間(prothrombin time,PT)、活化部分凝血酶原時(shí)間(activated partial prothrombin time,APTT)、凝血酶原活動(dòng)度(prothrombin activity,PTA)、國(guó)際標(biāo)準(zhǔn)化比值(international normalized ratio,INR)及尿酸(uric acid,UA)為重癥化CHB患者進(jìn)展為ACLF的危險(xiǎn)因素;3.多因素Logistic回歸分析發(fā)現(xiàn)HBV DNA、INR升高是重癥化CHB患者發(fā)展為ACLF的獨(dú)立危險(xiǎn)因素,建立預(yù)警模型方程式=-14.049+0.687×lgHBV DNA+4.798×INR;4.在驗(yàn)證組中本研究預(yù)警模型的AUC(0.764)明顯高于MELD(0.663)及MELD-Na(0.665),并且具有較高的敏感性(72.22%)、特異性(79.41%)和較好的陽(yáng)性似然比(3.51)、陰性似然比(0.35),且陽(yáng)性預(yù)測(cè)值(28.89%)明顯高于MELD(11.61%)及MELD-Na(15.22%)。對(duì)重癥化HBV感染者進(jìn)展為ACLF有較好的診斷價(jià)值。結(jié)論:重癥化CHB患者發(fā)展為ACLF的危險(xiǎn)因素包括高血清水平HBV DNA、TBIL,低血清水平GGT、CHE、PA、UA及凝血功能障礙;其中HBV DNA和INR升高是其獨(dú)立危險(xiǎn)因素;建立的預(yù)警模型對(duì)重癥化CHB患者進(jìn)展為ACLF具有較好的預(yù)警作用。
[Abstract]:Objective: to establish and verify the early warning model of chronic hepatitis liver failure in patients with severe chronic hepatitis B. methods: from January 2011 to February 2017, the hospital affiliated to Zunyi Medical College was retrospectively analyzed. The clinical data of 474 patients with severe chronic hepatitis B in our hospital; 252 patients were randomly divided into two groups: the modeling group and the other 222 patients. The single factor analysis was used to find out the risk factors of progression to ACLF, and the Logistic regression method was used to find out the independent risk factors and establish the early warning model. The early warning model was evaluated with receiver operating character curve and area under the curve. The model was compared with that of for end-stage liver disease model and MELDLD-Na model of end-stage liver disease. Results 1. 474 severe CHB patients who met the criteria of inclusion and exclusion were selected. There were 399 males, 75 females, 36 patients with ACLF, 28 males and 8 females, with an average age of 43.33 鹵10.29 years. The average age was 37.68 鹵11.26 years old. Univariate analysis showed that HBV DNA, gamma-glutamyl transpeptidase (GGTN), cholinesterase cholinesterase (cholinesterase), total bilirubin (total bilirubin), indirect bilirubin (Tbilirubin), indirect bilirubin, prealbumin, prothrombin, prothrombin, activated partial prothrombin. Prothrombin activity, international normalized activity, and uric acid acidosis were risk factors for progression to ACLF in patients with severe CHB. Multivariate Logistic regression analysis showed that the increase of HBV ACLF was an independent risk factor for the development of ACLF in patients with severe CHB. In the validation group, the AUC 0.764) of the early-warning model was significantly higher than that of MELDD 0.663) and MELD-NaO0.6650.665.The equation was highly sensitive and specific 79.41), and the positive likelihood ratio was 3.51%, the negative likelihood ratio was 0.35%, and the positive predictive value was 0.35%, and the positive likelihood ratio was 3.51%, the negative likelihood ratio was 0.35%, and the positive predictive value was 0.35%, with a high sensitivity of 72.22% and a specificity of 79.41%. Conclusion: the risk factors for the progression of severe HBV infection to ACLF include high serum HBV DNA til, low serum GGT CHEPAUA and coagulation dysfunction. The risk factors for the progression to ACLF in patients with severe CHB are significantly higher than that of MELDD 11.61) and MELD-NaH15.220.Conclusion: the risk factors for the progression to ACLF in patients with severe CHB include high serum HBV DNA til, low serum GGTCHEPAUA and coagulation dysfunction. The elevation of HBV DNA and INR were independent risk factors, and the established early warning model had a good early warning effect on the progression of severe CHB patients to ACLF.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R512.62;R575.3

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