本文選題：肝功能 + 診斷試驗(yàn)　； 參考：《蘇州大學(xué)》2015年碩士論文

【摘要】：目的:建立針對(duì)甲狀腺功能亢進(jìn)癥初診患者的肝功能檢驗(yàn)項(xiàng)目篩查模型,為臨床早期發(fā)現(xiàn)甲亢患者提供參考依據(jù),也為臨床判斷甲亢性肝損害提供指導(dǎo)性建議。方法:(1)甲狀腺功能亢進(jìn)癥初診患者的肝功能常規(guī)項(xiàng)目的評(píng)價(jià)及篩查模型的建立與驗(yàn)證查閱甲狀腺功能亢進(jìn)癥初診患者的病例352份和正常人群體檢結(jié)果434份,獲得13項(xiàng)[總膽紅素(TB)、直接膽紅素(DB)、間接膽紅素(FB)、總蛋白(TP)、白蛋白(ALB)、球蛋白(GLOB)、白蛋白與球蛋白的比值(A/G)、谷氨酸氨基轉(zhuǎn)移酶(ALT)、天門冬氨酸氨基轉(zhuǎn)移酶(AST)、γ-谷氨�；D(zhuǎn)移酶(GGT)、總膽汁酸(TBA)、乳酸脫氫酶(LDH)、堿性磷酸酶(ALP)]結(jié)果,留取120例甲狀腺功能亢進(jìn)癥初診患者和146份正常體檢人群的血清,測(cè)定以上13項(xiàng)指標(biāo)。通過比對(duì)ROC曲線下面積(AUC),評(píng)價(jià)各單項(xiàng)指標(biāo)對(duì)甲狀腺功能亢進(jìn)癥初診患者的診斷價(jià)值。以查閱病例組為訓(xùn)練組,運(yùn)用Logistic回歸統(tǒng)計(jì)方法,建立甲狀腺功能亢進(jìn)癥初診患者的肝功能常規(guī)檢驗(yàn)項(xiàng)目模型,以留取的血清組為驗(yàn)證組,對(duì)該模型進(jìn)行驗(yàn)證,評(píng)價(jià)模型的診斷價(jià)值。(2)尚未普及肝功能項(xiàng)目評(píng)價(jià)對(duì)留取120例甲狀腺功能亢進(jìn)癥初診患者和146份正常體檢人群的血清,同時(shí)測(cè)定6項(xiàng)尚未廣泛普及的肝功能檢查項(xiàng)目[5,-核苷酸酶(5,-NT),α-巖藻糖苷酶(AFU),單胺氧化酶(MAO),亮氨酸氨基肽酶(LAP),天門冬氨酸氨基轉(zhuǎn)移酶同工酶(m-AST),谷氨酸脫氫酶(GLDH)],通過比對(duì)ROC曲線下面積(AUC),評(píng)價(jià)6項(xiàng)指標(biāo)對(duì)甲狀腺功能亢進(jìn)癥初診患者的診斷價(jià)值,同樣運(yùn)用Logistic回歸統(tǒng)計(jì)方法,建立肝功能常規(guī)檢驗(yàn)項(xiàng)目和6項(xiàng)未普及項(xiàng)目對(duì)初發(fā)甲亢的聯(lián)合診斷模型,計(jì)算聯(lián)合模型的AUC,將聯(lián)合模型與肝功能常規(guī)模型進(jìn)行比較,并探討這6項(xiàng)指標(biāo)與常規(guī)肝功能檢驗(yàn)項(xiàng)目的相關(guān)性。為臨床選擇肝功能檢驗(yàn)項(xiàng)目提供參考(3)亮氨酸氨基肽酶(LAP)作為甲狀腺功能亢進(jìn)的一項(xiàng)獨(dú)立診斷指標(biāo)的探討將120例驗(yàn)證組的甲亢病例分為甲亢肝損害組和甲亢肝未損害組,比較LAP在這幾組中的均值與方差,并研究LAP與甲狀腺激素的相關(guān)性。結(jié)果:(1)肝功能常規(guī)項(xiàng)目檢查中,篩查甲狀腺功能亢進(jìn)癥初診患者時(shí)ROC曲線下面積(AUC)結(jié)果前三位依次為ALP(0.884);ALT(0.780);GGT(0.702),初發(fā)甲亢患者肝功能輔助診斷模型由DB、TP、GLOB、ALT、LDH、ALP 6項(xiàng)指標(biāo)組合構(gòu)建,訓(xùn)練組AUC為0.937,驗(yàn)證組AUC為0.958,總體差異為2.3%;當(dāng)診斷界值定位0.4時(shí),訓(xùn)練組診斷準(zhǔn)確率為90.2%,驗(yàn)證組診斷準(zhǔn)確率為90.5%。模型診斷與臨床診斷的一致性分析κ系數(shù)達(dá)到了0.807。(2)在尚未普及的肝功能檢驗(yàn)項(xiàng)目中,診斷初發(fā)甲亢AUC最大的為L(zhǎng)AP,達(dá)到了0.903,其余五項(xiàng)診斷價(jià)值較低。肝功能聯(lián)合診斷模型由TB、FB、TP、ALT、AST、ALP、LAP和5,-NT八項(xiàng)構(gòu)建,此時(shí)模型的AUC為0.982。相關(guān)系數(shù)最高的肝功能常規(guī)項(xiàng)目與未普及項(xiàng)目是:GLDH與AST(r=0.436,p0.01);m-AST與AST(r=0.742,p0.01);LAP與ALP(r=0.497,p0.01);MAO與GGT(r=0.245,p0.01);AFU與ALP(r=0.221,p0.01);5,-NT與GGT(r=0.537,p0.01)。(3)LAP在驗(yàn)證組甲亢整體組,驗(yàn)證組中甲亢伴肝損害組以及驗(yàn)證組中甲亢不伴肝損害組比較沒有統(tǒng)計(jì)學(xué)差異(p0.05),但與正常組比較均具有統(tǒng)計(jì)學(xué)差異(p0.05),LAP與FT3,FT4的相關(guān)系數(shù)達(dá)到了0.628,0.640,與TSH的相關(guān)系數(shù)為-0.743。結(jié)論:(1)在診斷初發(fā)甲亢中,肝功能常規(guī)檢驗(yàn)指標(biāo)具有一定的診斷價(jià)值,其中以ALP為最高;而以肝功能常規(guī)檢驗(yàn)指標(biāo)中DB、TP、GLOB、ALT、LDH、ALP建立的回歸模型具有很好的應(yīng)用價(jià)值。(2)在尚未普及的肝功能檢驗(yàn)項(xiàng)目中,只有LAP具有較高的診斷價(jià)值,因此在評(píng)判初發(fā)甲亢時(shí),臨床可不進(jìn)行其余五項(xiàng)的檢測(cè),以節(jié)約成本和時(shí)間。與肝功能常規(guī)檢驗(yàn)項(xiàng)目構(gòu)建的診斷甲亢模型相比,肝功能聯(lián)合模型雖然AUC有所提高,但綜合評(píng)價(jià)并沒有很大優(yōu)勢(shì),因此肝功能常規(guī)項(xiàng)目構(gòu)建的甲亢診斷模型完全能滿足臨床的篩查要求。(3)在初發(fā)甲亢中LAP的升高顯示是由于甲亢性引起的,與肝臟受不受損沒有關(guān)系,因此LAP建議作為診斷初發(fā)甲亢的一個(gè)獨(dú)立危險(xiǎn)指標(biāo),希望引起臨床注意。
[Abstract]:Objective: to establish a screening model of liver function test for patients with hyperthyroidism and to provide reference for early detection of hyperthyroidism and to provide guidance for clinical diagnosis of hyperthyroidism. Methods: (1) the evaluation and screening model of routine liver function items in the first diagnosed patients with hyperthyroidism 352 cases of first diagnosed patients with hyperthyroidism were established and 434 were examined in normal people. 13 items of total bilirubin (TB), direct bilirubin (DB), indirect bilirubin (FB), total protein (TP), albumin (ALB), globulin (GLOB), albumin to globulin (A/G), glutamate aminotransferase (ALT), aspartate ammonia were obtained. The results of aminotransferase (AST), gamma glutamyl transferase (GGT), total bile acid (TBA), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), were left to determine the above 13 indexes in 120 cases of primary hyperthyroidism and 146 normal physical examination people. By comparing the area under the ROC curve (AUC), the thyroid gland was evaluated for the thyroid gland. The diagnostic value of primary patients with hyperfunction of hyperfunction. In order to check case group as the training group, the Logistic regression method was used to establish a routine test model of liver function in the first diagnosed patients with hyperthyroidism, with the retained serum group as the validation group, the model was verified and the diagnostic value of the model was evaluated. (2) the liver function has not been popularized. The project evaluated the serum of 120 patients with primary hyperthyroidism and 146 normal people, and 6 items of liver function tests, [5, 5, -NT, alpha fucosidase (AFU), monoamine oxidase (MAO), leucine aminopeptidase (LAP), and aspartate aminotransferase isoenzyme (m-AST). Glutamate dehydrogenase (GLDH)), by comparing the area under the ROC curve (AUC), evaluate the diagnostic value of 6 indexes for the first diagnosed patients with hyperthyroidism, and also use the Logistic regression method to establish a joint diagnosis model of the liver function routine test and 6 unpopular items for primary hyperthyroidism, and calculate the AUC of the joint model. The combined model was compared with the routine liver function model, and the correlation between the 6 indexes and the routine liver function test project was discussed. The reference (3) LAP as an independent diagnostic indicator of hyperthyroidism was provided for the clinical selection of the liver function test. 120 cases of hyperthyroidism were divided into hyperthyroidism liver. The mean and variance of LAP in these groups were compared and the correlation between LAP and thyroid hormones was compared in the group of damage and hyperthyroidism. Results: (1) in the routine examination of liver function, the first three cases of ROC curve area (AUC) in the first diagnosis of hyperthyroidism were ALP (0.884); ALT (0.780); GGT (0.702), primary hyperthyroidism. The model of liver function assisted diagnosis was composed of 6 indexes, DB, TP, GLOB, ALT, LDH, ALP. The training group AUC was 0.937, the verification group AUC was 0.958, the total difference was 2.3%. The diagnostic accuracy of the training group was 90.2% when the diagnostic value was 0.4, and the diagnostic accuracy of the verification group was the consistency analysis kappa coefficient of the 90.5%. model diagnosis and the clinical diagnosis. 0.807. (2) in the unpopularized liver function test project, the largest AUC in the diagnosis of primary hyperthyroidism was LAP, reached 0.903, and the other five had lower diagnostic value. The joint diagnosis model of liver function was constructed by TB, FB, TP, ALT, AST, ALP, LAP and 5, -NT eight. The model AUC was the normal and unpopularized liver function item with the highest correlation coefficient. GLDH and AST (r=0.436, P0.01), m-AST and AST (r=0.742, P0.01), LAP and ALP (r=0.497, P0.01); 3) in the whole group of hyperthyroidism, there was no statistical difference between hyperthyroidism and liver damage group in the test group and the group of hyperthyroidism without liver damage. P0.05), but compared with the normal group, there were statistical differences (P0.05), LAP and FT3, FT4 correlation coefficient reached 0.628,0.640, and the correlation coefficient of TSH was -0.743. conclusion: (1) in the diagnosis of primary hyperthyroidism, the routine test index of liver function has certain diagnostic value, among which ALP is the highest, and DB, TP, GLOB, in the routine test of liver function. The regression model established by ALT, LDH and ALP has good application value. (2) only LAP has high diagnostic value in the liver function test project which has not been popularized. Therefore, in the evaluation of primary hyperthyroidism, the other five items can not be tested in order to save cost and time. The combined model of liver function has improved AUC, but the comprehensive evaluation does not have great advantages. Therefore, the hyperthyroidism diagnostic model constructed by the routine liver function project can fully meet the clinical screening requirements. (3) the elevation of LAP in the primary hyperthyroidism is due to hyperthyroidism and is not related to the liver damage. Therefore, LAP is recommended as a result. It is an independent risk factor for diagnosis of primary hyperthyroidism, and it hopes to attract clinical attention.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R581.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 石昌紅;王燕;管慶波;;甲狀腺功能亢進(jìn)癥與肝功能異常[J];中國(guó)醫(yī)師進(jìn)修雜志;2014年34期

2 徐銘益;陸倫根;;肝纖維化血清學(xué)標(biāo)志物及診斷模型的診斷價(jià)值[J];中華肝臟病雜志;2014年09期

3 張梅;;甲亢合并肝損害的診斷與治療[J];甘肅醫(yī)藥;2014年04期

4 鄭靖潔;汪麗娟;彭碧;;甲狀腺功能亢進(jìn)患者檢測(cè)肝功能的臨床意義[J];齊齊哈爾醫(yī)學(xué)院學(xué)報(bào);2014年01期

5 巫曉強(qiáng);;甲亢性肝損害116例臨床分析[J];蛇志;2013年04期

6 李敬彥;蔣寧一;;放射性碘[~(131)I]治療Graves甲亢合并重癥肝損害一例[J];新醫(yī)學(xué);2013年12期

7 黃明;田東昌;于志強(qiáng);;甲狀腺功能亢進(jìn)癥的中醫(yī)藥治療進(jìn)展[J];湖北中醫(yī)雜志;2013年11期

8 馬學(xué)芹;于世鵬;;初發(fā)Graves病患者~(131)I治療前后IL-23/Th17軸相關(guān)因子水平的變化及意義[J];中國(guó)免疫學(xué)雜志;2013年07期

9 袁招紅;李寧;汪興周;;精神病伴甲狀腺功能亢進(jìn)患者肝功能生化指標(biāo)分析[J];實(shí)驗(yàn)與檢驗(yàn)醫(yī)學(xué);2013年03期

10 葉晶珠;;甲亢性肝損害的127例臨床分析[J];江西醫(yī)藥;2012年12期

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