本文選題：血清學(xué)指標(biāo)　切入點(diǎn)：增強(qiáng)CT　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景及目的食管胃靜脈曲張破裂出血是肝硬化患者的主要死因之一。UGE(upper gastrointestinal endoscopy,上消化道內(nèi)鏡)檢查是EGV(esophagogastric varices,食管胃靜脈曲張)的診斷金標(biāo)準(zhǔn),但具有侵襲性。目前,已有很多研究探討了非侵襲性指標(biāo)評(píng)估EGV的準(zhǔn)確性。本研究旨在了解非侵襲性指標(biāo)中的血清學(xué)指標(biāo)與增強(qiáng)CT評(píng)估肝硬化EGV的準(zhǔn)確性。方法1.在Pub Med、EMBASE、CNKI和萬方數(shù)據(jù)庫(kù)中,檢索關(guān)于血清學(xué)指標(biāo)[包括APRI(aspartate aminotransferasetoplatelet ratio index,谷草轉(zhuǎn)氨酶/血小板比值指數(shù))、AAR(aspartate aminotransferasetoalanine aminotransferase ratio,谷草轉(zhuǎn)氨酶-谷丙轉(zhuǎn)氨酶比值)、FIB-4、FI、King、Lok、Forns和Fibro Index評(píng)分]預(yù)測(cè)肝硬化EGV的研究。計(jì)算其AUSROC(area under the summary receiver operating characteristic curves,擬合受試者工作特征曲線下面積)、敏感度、特異度、PLR(positive likelihood ratio,陽(yáng)性似然比)、NLR(negative likelihood ratio,陰性似然比)和DOR(diagnostic odds ratio,診斷比值比)。用QUADAS(Quality Assessment of Diagnostic Accuracy Studies,診斷準(zhǔn)確性研究質(zhì)量評(píng)估)對(duì)納入文獻(xiàn)進(jìn)行質(zhì)量評(píng)估。2.該回顧性研究納入了2012年1月至2014年6月連續(xù)入住我院且行UGE檢查的肝硬化患者,評(píng)估血清學(xué)指標(biāo)(包括APRI、AAR、FIB-4、Lok和Forns評(píng)分)預(yù)測(cè)EV(esophageal varices,食管靜脈曲張)的準(zhǔn)確性。計(jì)算AUC(area under curves,曲線下面積)、敏感度和特異度。根據(jù)UGIB(upper gastrointestinal bleeding,上消化道出血)史及脾切除/脾動(dòng)脈栓塞史進(jìn)行亞組分析。3.在Pub Med和EMBASE數(shù)據(jù)庫(kù)中,檢索關(guān)于增強(qiáng)CT(computed tomography,計(jì)算機(jī)斷層掃描)診斷肝硬化EGV準(zhǔn)確性的研究。計(jì)算AUSROC、敏感度、特異度、PLR、NLR和DOR。根據(jù)EGV位置、CT技術(shù)和研究設(shè)計(jì)進(jìn)行亞組分析。應(yīng)用QUADAS-2對(duì)納入文獻(xiàn)進(jìn)行質(zhì)量評(píng)估。4.該回顧性研究納入2012年6月到2014年6月連續(xù)入住我院且行增強(qiáng)CT和UGE檢查的肝硬化患者,評(píng)估增強(qiáng)CT診斷EV的準(zhǔn)確性。兩個(gè)觀察者分別判斷增強(qiáng)CT圖像上有無EV并對(duì)其最大直徑進(jìn)行測(cè)量。計(jì)算AUC、敏感度和特異度。結(jié)果1.APRI、AAR、FIB-4、FI、King、Lok、Forns和Fibro Index評(píng)分各納入了12、4、5、0、0、4、3和1項(xiàng)研究。APRI、AAR、FIB-4、Lok和Forns評(píng)分預(yù)測(cè)EGV的AUSROC分別為0.6774、0.7275、0.7755、0.7885和0.7517,預(yù)測(cè)高危EGV的AUSROC分別為0.7278、0.7448、0.7095、0.7264和0.653。FIB-4和Forns評(píng)分預(yù)測(cè)EGV時(shí)存在顯著的閾值效應(yīng)。APRI、AAR和Lok評(píng)分預(yù)測(cè)EGV的敏感度/特異度/PLR/NLR/DOR分別為0.6/0.67/1.77/0.58/3.13、0.64/0.63/1.97/0.54/4.18和0.74/0.68/2.34/0.4/5.76。APRI、AAR、FIB-4、Lok和Forns評(píng)分預(yù)測(cè)高危EGV的敏感度/特異度/PLR/NLR/DOR分別為0.65/0.66/2.15/0.47/4.97、0.68/0.58/2.07/0.54/3.93、0.62/0.64/2.02/0.56/3.57、0.78/0.63/2.09/0.37/5.55和0.65/0.61/1.62/0.59/2.75。2.共納入650例完善血清學(xué)指標(biāo)且行UGE檢查的肝硬化患者。根據(jù)UGE檢查結(jié)果,81.4%的患者有中-重度EV。在整體分析中,血清學(xué)指標(biāo)預(yù)測(cè)中-重度EV和EV的AUC分別為0.506-0.6和0.539-0.612。在無UGIB史的亞組分析患者中,預(yù)測(cè)中-重度EV和EV的AUC分別為0.601-0.664和0.596-0.662。在無UGIB史及脾切除/脾動(dòng)脈栓塞史的亞組分析患者中,預(yù)測(cè)中-重度EV和EV的AUC分別為0.627-0.69和0.607-0.692。3.共納入17項(xiàng)用增強(qiáng)CT診斷肝硬化EGV的研究,總體研究質(zhì)量中等。CT預(yù)測(cè)EGV和高危EGV的AUSROC分別為0.8975和0.9494。預(yù)測(cè)EGV和高危EGV的擬合敏感度/特異度/PLR/NLR/DOR分別為0.87/0.8/3.67/0.18/22.7和0.87/0.88/7.52/0.12/65.55。亞組分析中,根據(jù)EGV的位置,預(yù)測(cè)胃靜脈曲張的AUSROC為0.9127,預(yù)測(cè)EV和高危EV的AUSROC為0.8958和0.9461。根據(jù)CT技術(shù),MDCT(multi-detector CT,多排CT)預(yù)測(cè)EGV和高危EGV的AUSROC分別為0.9047和0.949,MDCT食管造影術(shù)預(yù)測(cè)EGV和高危EGV的AUSROC分別為0.8735和0.9664。在前瞻性研究的亞組分析中,預(yù)測(cè)EGV和高危EGV的AUSROC分別為0.9122和0.9507。4.共納入52例行增強(qiáng)CT和UGE檢查的肝硬化患者。根據(jù)UGE檢查結(jié)果,13.5%的患者無EV,11.5%的患者存在輕度EV,75%的患者存在中-重度EV。增強(qiáng)CT預(yù)測(cè)EV的AUC為0.835,敏感度和特異度分別為95.56%和71.43%。增強(qiáng)CT預(yù)測(cè)中-重度EV的AUC為0.821。當(dāng)臨界值為3.9mm時(shí),預(yù)測(cè)中-重度EV的敏感度和特異度分別為89.74%和69.23%。結(jié)論血清學(xué)指標(biāo)預(yù)測(cè)肝硬化EGV有低-中度準(zhǔn)確性,無法代替UGE檢查;增強(qiáng)CT診斷肝硬化EGV有較高準(zhǔn)確性,可將其應(yīng)用于臨床減少UGE的使用率。
[Abstract]:Background and objective esophageal variceal hemorrhage is one of the main causes of death in patients with liver cirrhosis (.UGE upper gastrointestinal endoscopy, upper gastrointestinal endoscopy examination (esophagogastric) is EGV varices, esophageal and gastric varices) diagnostic gold standard, but aggressive. At present, there has been a lot of research on the accuracy of non invasive evaluation index EGV this study aims to understand the serological indexes of non invasive index and enhance the accuracy of evaluation of CT EGV in patients with liver cirrhosis. Methods 1. in Pub Med, EMBASE, CNKI and Wanfang database, retrieval on serum indexes including APRI (aspartate aminotransferasetoplatelet ratio index, aspartate aminotransferase to platelet ratio index (aspartate), AAR aminotransferasetoalanine aminotransferase ratio, AST - ALT), FIB-4, FI, King, Lok, Forns and Fibro Index were predicted Study of hepatic cirrhosis and EGV. Calculate the AUSROC (area under the summary receiver operating area characteristic curves, fitting under the receiver operating characteristic curve), sensitivity, specificity, PLR (positive likelihood ratio, positive likelihood ratio (negative), NLR likelihood ratio, negative likelihood ratio (diagnostic) and DOR odds ratio, diagnosis the odds ratio (Quality). QUADAS Assessment of Diagnostic Accuracy Studies, the diagnosis accuracy of quality assessment) for the quality of the included studies evaluating.2. this retrospective study included in January 2012 to June 2014 in our hospital and underwent UGE examination in patients with liver cirrhosis, serological indicators (including APRI, AAR, FIB-4, Lok and Forns score) EV (esophageal varices, esophageal varices). The accuracy of the calculation of AUC (area under curves, the area under the curve), sensitivity and specificity. According to UGIB (upper Gastr Ointestinal bleeding, upper gastrointestinal bleeding history) and splenectomy / splenic artery embolization history of the subgroup analysis of.3. in Pub Med and EMBASE database, retrieval on enhanced CT (computed tomography, computed tomography) in diagnosis of liver cirrhosis. The accuracy of EGV calculation of AUSROC, sensitivity, specificity, PLR, NLR and DOR. according to the the location of the EGV and CT technology research and design of subgroup analysis. To evaluate the quality of.4. this retrospective study included in the June 2012 to June 2014 in our hospital and underwent enhanced CT and UGE examination in patients with liver cirrhosis by QUADAS-2 in literature, evaluate the diagnostic accuracy of CT EV enhanced. Two observers were judged on CT images with and without EV and the measurement of the largest diameter increased. Calculation of AUC, sensitivity and specificity. The results of 1.APRI, AAR, FIB-4, FI, King, Lok, Forns and Fibro Index 12,4,5,0,0,4,3 and the score of each included 1 studies.AP RI, AAR, FIB-4, Lok and Forns score in predicting EGV AUSROC were 0.6774,0.7275,0.7755,0.7885 and 0.7517, respectively. The AUSROC prediction of high risk EGV 0.7278,0.7448,0.7095,0.7264 and 0.653.FIB-4 EGV and Forns score to predict there is.APRI significant threshold effect, AAR and Lok scores predict EGV sensitivity / specificity of /PLR/NLR/DOR were 0.6/0.67/1.77/0.58/3.13,0.64/0.63/1.97/0.54/4.18 and 0.74/0.68/2.34/0.4/5.76.APRI, AAR FIB-4, Forns, Lok and EGV risk score to predict the sensitivity / specificity of /PLR/NLR/DOR were 0.65/0.66/2.15/0.47/4.97,0.68/0.58/ 2.07/0.54/3.93,0.62/0.64/2.02/0.56/3.57,0.78/0.63/2.09/0.37/5.55 and 0.65/0.61/1.62/0.59/2.75.2. included a total of 650 cases of patients with liver cirrhosis and improve serum index of UGE examination. According to the results of UGE examination, 81.4% patients with moderate to severe EV. in the overall analysis, serological indicators In severe EV and EV AUC were 0.506-0.6 and 0.539-0.612. in UGIB history of the subgroup analysis of patients, prediction of moderate and severe EV and EV AUC were 0.601-0.664 and 0.596-0.662. in UGIB history and splenectomy / splenic artery thrombosis subgroup analysis in patients with moderate to severe EV and forecast EV AUC were 0.627-0.69 and 0.607-0.692.3. included 17 items with enhanced CT diagnosis of liver cirrhosis EGV, the quality of the overall research medium.CT prediction fitting EGV and high risk EGV AUSROC 0.8975 and 0.9494. respectively to predict EGV and high risk EGV sensitivity / specificity of /PLR/NLR/DOR were 0.87 /0.8/3.67/0.18/22.7 and 0.87/0.88/7.52/0.12/65.55. subgroup analysis, according to EGV the location prediction of gastric varices was 0.9127 AUSROC, EV and EV AUSROC risk prediction is 0.8958 and 0.9461. based on CT technology, MDCT (multi-detector CT, CT EGV and multi row) prediction of high risk EGV AUSR OC were 0.9047 and 0.949, MDCT esophageal angiography predict EGV and high risk EGV AUSROC 0.8735 and 0.9664. respectively in the prospective study of the subgroup analysis, prediction of EGV and high risk EGV AUSROC 0.9122 and 0.9507.4. respectively were included 52 cases of enhanced CT and UGE examination in patients with liver cirrhosis. According to the results of UGE test, 13.5% the patients without EV, there were 11.5% patients with mild EV, 75% patients with moderate to severe EV. enhanced CT prediction of EV AUC was 0.835, sensitivity and specificity were 95.56% and 71.43%. enhanced CT in prediction of severe EV AUC 0.821. when the critical value is 3.9mm, the prediction of moderate and severe EV sensitive the degree and specificity of serological index 89.74% and 69.23%. conclusion predicting cirrhosis EGV has low to moderate accuracy, can replace the UGE examination; enhanced CT diagnosis of liver cirrhosis EGV has high accuracy, which can be applied to reduce the clinical UGE usage.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R575.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 Ke Pu;Jing-Hong Shi;Xu Wang;Qian Tang;Xin-Jie Wang;Kai-Lin Tang;Zhong-Qi Long;Xing-Sheng Hu;;Diagnostic accuracy of transient elastography (Fibro Scan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis[J];World Journal of Gastroenterology;2017年02期

2 馮潔;潘存?zhèn)?黃成軍;;APRI、AAR對(duì)肝硬化食管靜脈曲張的診斷價(jià)值[J];現(xiàn)代消化及介入診療;2013年03期

3 Hyojin Kim;Dongil Choi;Joon Hyeok Lee;Soon Jin Lee;Hangi Jo;Geum-Youn Gwak;Kwang Cheol Koh;Moon Seok Choi;Seonwoo Kim;;High-risk esophageal varices in patients treated with locoregional therapy for hepatocellular carcinoma:Assessment with liver computed tomography[J];World Journal of Gastroenterology;2012年35期

4 郭成偉;全顯躍;方馳華;項(xiàng)楠;梁文;;64層螺旋CT門靜脈造影對(duì)門靜脈高壓側(cè)支循環(huán)的研究[J];中國(guó)醫(yī)學(xué)影像技術(shù);2008年06期

，

本文編號(hào)：1575940