本文關(guān)鍵詞：幾種血液指標(biāo)在炎癥性腸病初步診斷及活動度評價中的作用，由筆耕文化傳播整理發(fā)布。

        目的：(1)觀察幾種血液指標(biāo)，包括血紅蛋白(HGB)、平均紅細胞體積(MCV)、血小板計數(shù)(PLT)、紅細胞分布寬度(RDW)、血沉(ESR)、超敏C反應(yīng)蛋白(CRP)、平均血小板容積(MPV)在IBD組和健康對照組、IBD兩種亞型(克羅恩病，CD；潰瘍性結(jié)腸炎，UC)組及IBD亞型不同活動度組間的水平有無差別。(2)評價上述指標(biāo)在IBD的初步診斷、臨床亞型鑒別、疾病活動程度評價中的靈敏度和特異度。(3)采用診斷性meta分析，系統(tǒng)、定量地評價紅細胞分布寬度(RDW)在IBD疾病活動度評價中的作用。方法：(1)收集于2008年6月到2012年6月期間在蘇州市立醫(yī)院(北區(qū))消化科住院，年齡為18至65周歲，，長期居住于蘇州地區(qū)，無IBD家族史，經(jīng)綜合診斷確診為IBD的患者130例(60例CD，70例UC)，及在該院體檢中心進行體檢的與IBD患者性別、年齡匹配的健康對照者130例。收集患者的住院資料及患者和健康對照的血液檢查結(jié)果。(2)分別采用克羅恩病疾病活動度指數(shù)(Crohn’s disease activity index, CDAI)和修正的Truelove-Witts指數(shù)對CD和UC患者的疾病活動度進行評分�；顒悠贑D定義為CD患者CDAI評分≥150，活動期UC定義修正的Truelove-Witts評分≥11分。為分析比較各血液指標(biāo)在IBD和健康對照組、CD和UC組、活動期和緩解期CD組、活動期和緩解期UC組間水平(均數(shù)或中位數(shù))有無顯著差別；采用受試者工作特征曲線(receiver operating curve, ROC)分析上述幾種血液指標(biāo)在IBD的初步診斷、亞型鑒別、活動度評價中的曲線下面積(area under the curve, AUC)、靈敏度、特異度。以上統(tǒng)計用SPSS17.0完成。(3)系統(tǒng)檢索Medline、ISI Web of Knowledge、谷歌學(xué)術(shù)和中國知網(wǎng)中2013年2月1日以前發(fā)表的研究RDW評價IBD疾病活動度的文獻。采用二元混合效應(yīng)回歸模型計算合并的靈敏度、特異度及ROC曲線下面積值及其95%可信區(qū)間。此部分統(tǒng)計分析用STATA12.0統(tǒng)計軟件完成。結(jié)果：(1)各指標(biāo)在IBD組和健康對照組間水平都存在顯著差異(P＜0.05)。(2) ESR和CRP可較好鑒別IBD組和健康對照組，ROC曲線下面積分別為0.88和0.86，靈敏度/特異度分別為79%/85%(ESR切點9.5mm/h)和82%/79%(CRP切點4.6mg/L)。(3) RDW和MCV可較好區(qū)分CD和UC，曲線下面積分別為0.81和0.80，靈敏度/特異度分別為76%/72%(RDW切點13.5)和70%/73%(MCV切點87.9fL)，亞組分析進一進步發(fā)現(xiàn)RDW鑒別CD和UC的效果僅限于活動期IBD。(4)關(guān)于IBD疾病活動度的評估結(jié)果發(fā)現(xiàn)，評價CD疾病活動度最好的指標(biāo)依次是CRP、RDW和ESR，曲線下面積都大于0.80，當(dāng)CRP取6.5mg/L時，其鑒別活動期和緩解期CD的靈敏度和特異度分別為85%和75%；而幾種指標(biāo)中未發(fā)現(xiàn)能較好評估UC活動度的指標(biāo)，效果最好的RDW，其ROC曲線下面積僅為0.73.(5)診斷性meta分析納入6項研究，包含996例IBD患者(451例CD，545例UC)。結(jié)果顯示，RDW可較好區(qū)分活動期與緩解期CD，合并的靈敏度、特異度及ROC曲線下面積分別為79%(95%CI,70-85%)、0.78%(95%CI,68-88%)和0.84(95%CI,0.81-0.87)；RDW評價UC活動度有較高特異度(79%)，但靈敏度較低(64%)。結(jié)論：CRP和ESR可作為IBD初步診斷、疾病活動度評價(主要是CD活動度評價)的敏感、特異的指標(biāo)；RDW或可作為IBD臨床亞型鑒別和疾病活動度評價(主要是CD活動度評價)的簡便、廉價、敏感、特異的新指標(biāo)。

    Objective:1. To investigate whether there were significant differences in the distribution ofseveral selected blood parameters, including hemoglobin (HGB), mean corpuscularvolume (MCV), platelet count(PLT), red cell distribution width(RDW), erythrocytesedimentation rate (ESR), C-reactive protein (CRP) and mean platelet volume (MPV)between inflammatory bowel disease (IBD) and healthy control groups, or betweenCrohn’s disease (CD) and Ulcerative Colitis (UC) groups, or active and inactive IBDgroups.2. To evaluate the role of these parameters in the initial diagnosis, subtypediscrimination and activity assessment of IBD.3. To assess the role of RDW in the activity assessment of IBD by conducting adiagnostic meta-analysis.Methods：1. One hundred thirty IBD patients (including60CD and70UC) who wereresiding in Suzhou, aged18to65years and had no family history of IBD were enrolled.All patients hospitalized in Department of Gastroenterology of Suzhou MunicipalHospital (North Campus) between June2008and June2012, and were confirmed tohave been suffering from IBD according to comprehensive diagnosis. The patients werematched to130healthy controls who were free of IBD and other gastrointestinaldiseases by age and sex. Hospitalization data for patients and the data of blood test forboth IBD and controls were collected.2. The activity of the disease was assessed using the Crohn’s disease activity index(CDAI) for CD patients and the corrected Truelove-Witts index for UC patients,respectively. Active disease was defined as a CDAS of at least150for CD and a corrected Truelove-Witts index of at least11. The mean or median levels of theparameters between IBD and controls, CD and UC, active and inactive CD, active andinactive UC were respectively evaluated to detect whether there were significantdifferences in the levels of these parameters between groups. Receiver operating curve(ROC) analysis was used to determine the area under the curve (AUC), sensitivity andspecificity of these parameters in distinguishing IBD and controls, CD and UC, andactive and inactive IBD.3. A comprehensive literature search was conducted by use of multiple databasescovering Medline, ISI Web of Knowledge, Google Scholar and CNKI. A bivariatemixed-effects regression model was assigned to calculate the combined sensitivity,specificity and the AUC of RDW in assessing disease activity of IBD.Results:1. There were statistically significant differences in the levels of each parameterbetween IBD and controls (P＜0.05).2. ESR and CRP were each found to be effective in distinguishing IBD andhealthy controls, with an AUC of0.88and0.86, sensitivity of79%and82%, andspecificity of85%and79%, respectively (cut-off value was9.5mm/h for ESR and4.6mg/L for CRP).3. RDW and MCV were each shown to be effective in distinguishing CD andUC, with an AUC of0.81and0.80, sensitivity of76%and70%, and specificity of72%and73%, respectively (cut-off value was13.5for RDW and87.9fL forMCV). Further analyses found that the observed diagnostic value of RDW waslimited in distinguishing active CD and active UC.4. CRP followed by RDW and ESR were effective in the activity assessmentof CD, all with AUCs of over0.80. CRP had a sensitivity and a specificity of85%and75%, respectively, in discrimination between active and inactive CD, whengiven a cut-off value of6.5mg/L; none of the studied blood parameters was shown tobe able to effectively evaluate the activity of UC, with the most effective one (RDW)achieving an AUC of merely0.73.5. Six studies that totaled996IBD patients (451CD and545UC) were included inthe diagnostic meta-analysis. The combined sensitivity and specificity for RDW todetect active patients among CD was79%(95%CI,70-85%) and78%(95%CI， 68-88%), and the combined AUC was0.84(95%CI,0.81-0.87); Whereas RDW wasshown to specifically (79%), but not sensitively (64%) detect active patients among UC.Conclusion:Both CRP and ESR are sensitive and specific in the initial diagnosis and activityassessment of IBD (limited to CD); RDW may serve as a new parameter in blood that issimple, inexpensive, sensitive and specific in the discrimination of subtypes and activityassessment of IBD (limited to CD).

幾種血液指標(biāo)在炎癥性腸病初步診斷及活動度評價中的作用

中文摘要4-6Abstract6-8引言10-13第一部分 幾種血液指標(biāo)在炎癥性腸病初步診斷及活動度評價中的作用13-25    一、研究對象與方法13-16    二、研究結(jié)果與分析16-25第二部分 紅細胞分布寬度評價炎癥性腸病活動度的 meta 分析25-39    一、研究對象與方法25-26    二、研究結(jié)果與分析26-33    三、討論與結(jié)論33-39參考文獻39-49綜述49-63    參考文獻57-63中英文縮寫詞語對照表63-64碩士研究生期間發(fā)表的論文64-66致謝66-67

  本文關(guān)鍵詞：幾種血液指標(biāo)在炎癥性腸病初步診斷及活動度評價中的作用，由筆耕文化傳播整理發(fā)布。