本文選題：慢性乙型肝炎 + 食管靜脈曲張　； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景我國是乙肝第一流行大國,很多患者最終都進(jìn)入了肝功能衰竭的晚期肝硬化期,其中伴隨著大量并發(fā)癥。食管靜脈曲張(Esophageal Varices,EV)是慢性乙肝肝硬化最常見的并發(fā)癥,多突發(fā)大量嘔血和(或)便血,常為大量出血,出現(xiàn)心慌、乏力、胸悶等全身癥狀,嚴(yán)重時引起出血性休克,誘發(fā)肝性腦病。EV破裂出血是肝硬化最常見、高死亡率的并發(fā)癥,在第一次出血后,70%的患者會再次出血,故對EV的早期發(fā)現(xiàn)及治療非常重要。臨床上診斷EV廣泛應(yīng)用的診斷方法是上消化道內(nèi)鏡,內(nèi)鏡為侵入性診斷,極易出現(xiàn)操作過程中急性出血、麻醉意外等并發(fā)癥,且病人較難耐受。無創(chuàng)血清學(xué)模型是血常規(guī)、肝功能、凝血四項檢查所得指標(biāo)通過相關(guān)公式建議起來的模型,近些年來備受關(guān)注,其中個別已被一些指南收錄。瞬時彈性測定(Fibroscan,FS)是以超聲為基礎(chǔ)對肝纖維化進(jìn)行測定,目前在臨床上已廣泛應(yīng)用。目的比較無創(chuàng)血清學(xué)模型(AAR、APRI、GPRI、S index、API、Fibro-Q、King)和FS預(yù)測慢性乙型肝炎患者重度食管靜脈曲張的診斷效能,探討這些血清學(xué)模型與FS聯(lián)合后的診斷價值。方法納入慢性乙型肝炎患者140例,均行胃鏡、血常規(guī)、肝功能、凝血四項檢查(均為入院后2天內(nèi)出血),計算出AST/ALT比值(AAR模型)、AST/PLT比值(APRI模型)、GGT/PLT比值(GPRI模型)、GGT-PLT-ASB比值(S-index模型)、與age-PLT相關(guān)的指數(shù)(API模型)、age-AST-INR-PLT-ALT相關(guān)的比值(Fibro-Q模型)、age-AST-INR-PLT相關(guān)的比值(King模型),利用瞬時彈性測定(FS)對納入者肝臟硬度進(jìn)行測量,EV以內(nèi)鏡診斷為金標(biāo)準(zhǔn),應(yīng)用這些數(shù)據(jù)建立模型進(jìn)行回顧性研究,數(shù)據(jù)分析采用受試者工作曲線。結(jié)果AAR、GPRI、S-index、APRI、API、Fibro-Q、King、FS預(yù)測重度食管靜脈曲張的ROC曲線下面積分別為0.430、0.800、0.801、0.777、0.612、0.750、0.804、0.890。其中GPRI、S-index、King、FS預(yù)測EV的價值較AAR、APRI、API、Fibro-Q更為顯著,而其敏感度、特異度分別為0.805、0.586,0.878、0.586,0.878、0.657,0.951、0.747。由此可見,FS敏感度、特異度均較高,相關(guān)性較好,預(yù)測價值最佳。將FS與GPRI、S-index、King兩兩聯(lián)合后曲線下面積分別為:0.899(P0.01)、0.892(P0.01)、0.891(P0.01),與單獨應(yīng)用GPRI、S-index、King相比差異均有統(tǒng)計學(xué)意義。結(jié)論這些無創(chuàng)檢查中,GPRI、S-index、King、Fibroscan對重度食管靜脈曲張預(yù)測具有很好的診斷準(zhǔn)確性,Fibroscan的診斷價值最好,GPRI、S-index、King較FS稍差,而APRI、API、Fibro-Q對重度食管靜脈曲張預(yù)測價值一般,AAR未發(fā)現(xiàn)有明顯診斷價值;Fibroscan與GPRI、S-index、King兩兩聯(lián)合要比單純應(yīng)用Fibroscan預(yù)測價值更高,可以作為內(nèi)鏡檢查的良好補(bǔ)充和替代方案。
[Abstract]:Background China is the first country of hepatitis B epidemic, many patients have finally entered the stage of liver failure of advanced cirrhosis, which accompanied by a large number of complications. Esophageal varices-EV is the most common complication of chronic hepatitis B cirrhosis. Induced hepatic encephalopathy bleeding is the most common complication of cirrhosis with high mortality. 70% of the patients will bleed again after the first hemorrhage, so it is very important for the early detection and treatment of EV. The clinical diagnosis of EV is widely used by endoscopy of upper digestive tract, which is an invasive diagnosis. It is easy to occur complications such as acute bleeding and anaesthesia accident in the course of operation, and the patients are difficult to tolerate. Non-invasive serological model is a model suggested by four indexes of blood routine, liver function and coagulation through relevant formulas, which has attracted much attention in recent years, some of which have been included in some guidelines. Transient elastic measurement (FibroscanFS), which is based on ultrasound, has been widely used in clinical practice. Objective to compare the diagnostic efficacy of noninvasive serological models (AARA APRIN GPRIS) and FS in predicting severe esophageal varices in patients with chronic hepatitis B (CHB), and to explore the diagnostic value of these serological models combined with FS. Methods 140 patients with chronic hepatitis B were treated with gastroscopy, blood routine examination and liver function. Four tests of coagulation (bleeding within 2 days after admission) were performed. The AST / alt ratio (AAR model) and the GGT / PLT / PLT ratio (GPRI model) were calculated. The age-AST-INR-PLT-associated ratio (Fibro-Q model) was calculated as the index (API model) associated with age-PLT (the ratio of age-AST-INR-PLT-ALT) and the age-AST-INR-PLT ratio (Fibro-Q model). Value (King model), using transient elastic measurement (FS) to measure the liver hardness of the participants and using endoscopic diagnosis as the gold standard. These data were used to establish a model for retrospective study, and the data were analyzed using the operating curve of subjects. Results the areas under the ROC curve for predicting severe esophageal varices with AARA GPRI S-index-APRI Fibro-QN KingFS were 0.430 ~ 0.800 ~ 0.801 ~ 0.7770.7012 ~ 0.750 ~ (0.804) ~ 0.890, respectively. The value of GPRI S-indexer KingFS in predicting EV was more significant than that in AARA APRI, and its sensitivity and specificity were 0.8050.586C 0.878N 0.878N 0.657N 0.951N 0.747, respectively. It can be seen that the sensitivity and specificity of FS are higher, the correlation is better, and the predictive value is the best. The area under the back curve of FS and GPRII-S-indexKing was 0.899 (P0.01), 0.892 (P0.01) and 0.891 (P0.01), respectively. There were significant differences between FS and GPRI S-indexKing alone. Conclusion Fibroscan has a good diagnostic accuracy in predicting severe esophageal varices. The diagnostic value of Fibroscan is better than that of FS. The predictive value of Fibro-Q for severe esophageal varices in APRII was generally not found to have significant diagnostic value. The combination of Fibroscan and GPRII-S-indexKing was more valuable than that of Fibroscan alone, and could be used as a good supplement and substitute for endoscopic examination.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R575.2;R512.62
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本文編號：2087700