本文選題：肝纖維化　切入點(diǎn)：病理學(xué)　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:研究血小板(platelet PLT)計(jì)數(shù)與慢性肝病肝臟纖維化分期的關(guān)系,探討PLT計(jì)數(shù)在預(yù)測(cè)慢性肝病肝臟纖維化分期的價(jià)值。方法:采用回顧性分析,收集慢性肝病患者138例作為實(shí)驗(yàn)組。收集健康體檢者414例作為對(duì)照組,收集實(shí)驗(yàn)組的年齡、性別、血常規(guī)、肝功能、肝穿刺活檢組織,對(duì)照組年齡、性別、血常規(guī)。肝臟組織病理參照2000年西安全國(guó)病毒性肝炎及肝病學(xué)術(shù)會(huì)議修訂的標(biāo)準(zhǔn)。比較實(shí)驗(yàn)組與對(duì)照組男女構(gòu)成比、年齡、PLT計(jì)數(shù)的差異有無統(tǒng)計(jì)學(xué)意義。采用最優(yōu)分箱方法進(jìn)行數(shù)據(jù)預(yù)處理,繪制實(shí)驗(yàn)組肝纖維化分期與PLT計(jì)數(shù)受試者工作特征(ROC)曲線,選取診斷實(shí)驗(yàn)組肝纖維化分期敏感性及特異性近似70%時(shí),實(shí)驗(yàn)組不同肝纖維化分期時(shí)對(duì)應(yīng)PLT計(jì)數(shù)的截?cái)嘀?并且與目前常用的APRI、FIB-4診斷模型比較特異性及敏感性。繪制實(shí)驗(yàn)組不同肝纖維化分期時(shí)與PLT計(jì)數(shù)的階梯曲線。結(jié)果:(1)實(shí)驗(yàn)組與對(duì)照組年齡、性別構(gòu)成比無差異(實(shí)驗(yàn)組:39.2±11.2歲,男105例,女性33例;對(duì)照組39.2±8.5歲,男321例,女性93例);實(shí)驗(yàn)組與對(duì)照組PLT計(jì)數(shù)存在差異(187.7±53.4X109/L比283.5±63.9X109/L,P0.01)(2)實(shí)驗(yàn)組中各纖維化分期的PLT計(jì)數(shù)分別為S0:214.0±24.8X109/L,S1:219.7±51.3X109/L,S2:191.5±48.9X109/L,S3:169.6±43.2X109/L,S4:148.6±44.5X109/L。進(jìn)一步進(jìn)行方差分析兩兩對(duì)比發(fā)現(xiàn)S4組與S0、S1、S2組、S1組與S3組PLT計(jì)數(shù)差異有統(tǒng)計(jì)學(xué)意義(P0.01),其余兩組PLT計(jì)數(shù)之間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(3)實(shí)驗(yàn)組PLT計(jì)數(shù)181×109/L,肝臟組織病理≤S1(6例),≥S2(36例);PLT≥181×109/L,肝臟組織病理≤S1(56例),≥S2(40例)。(4)在實(shí)驗(yàn)組PLT計(jì)數(shù)與肝纖維化的ROC曲線上選取敏感性近似70%時(shí)的PLT計(jì)數(shù)截?cái)嘀礢1=211.5x109/L,S2=199x109/L,S3=180x109/L,S4=173x109/L。(5)在實(shí)驗(yàn)組PLT計(jì)數(shù)、APRI、FIB-4與肝纖維化的ROC曲線上敏感性近似70%時(shí)的特異性,S1(50%、50%、100%)、S2(69%、50%、69%)、S3(69%、63.2%、52.9%)、S4(69.4%、62.9%、54.1%)。結(jié)論:1、慢性肝病病人PLT計(jì)數(shù)比健康人PLT計(jì)數(shù)低。2、在慢性肝病病人中,PLT計(jì)數(shù)181x109/L時(shí),90.3%的病人肝纖維化≥S2。3、PLT計(jì)數(shù)預(yù)測(cè)慢性肝病病人肝纖維化S1、S2、S3、S4敏感性近似70%時(shí)的截?cái)嘀凳?211.5x109/L、199x109/L、180x109/L、173x109/L。4、PLT計(jì)數(shù)可以初步預(yù)測(cè)慢性肝病肝纖維化分期。
[Abstract]:Aim: to study the relationship between platelet platelet PLT count and hepatic fibrosis stage of chronic liver disease, and to explore the value of PLT count in predicting hepatic fibrosis stage of chronic liver disease.Methods: 138 patients with chronic liver disease were collected as experimental group by retrospective analysis.The age, sex, blood routine, liver function, liver biopsy tissue, age, sex and blood routine of the experimental group were collected.Liver histopathology refers to the revised standards of Xi'an National Conference on viral Hepatitis and liver Diseases in 2000.The difference of age and PLT between the experimental group and the control group was statistically significant.The optimal box method was used to preprocess the data, and the curves of hepatic fibrosis stage and PLT counting were drawn. The sensitivity and specificity of hepatic fibrosis staging in the experimental group were approximately 70%, while the sensitivity and specificity of hepatic fibrosis staging in the experimental group were approximately 70%.In the experimental group, the truncation value of PLT count was corresponding to different stages of hepatic fibrosis, and the specificity and sensitivity of the experimental group were compared with the commonly used APRII-FIB-4 diagnostic model.The ladder curves of PLT count and different stages of hepatic fibrosis were plotted in the experimental group.Results there was no difference in age and sex ratio between experimental group and control group (experiment group: 39.2 鹵11.2 years old, male 105 cases, female 33 cases, control group 39.2 鹵8.5 years old, male 321 cases, control group 39.2 鹵8.5 years old, male 321 cases).The sensitivity on the ROC curve is approximately 70. The sensitivity of S1 is about 50 and the sensitivity is about 50 and 50. The sensitivity of S1 is about 50. The sensitivity of S1 is about 50. The sensitivity of S1 is approximately 70. The sensitivity of S1 is approximately 70. The sensitivity of S1 is approximately 70. The sensitivity of S1 is approximately 70. The sensitivity of S1 is approximately 70. The sensitivity of S1 is approximately 70. The sensitivity of S1 is about 50.The PLT counts of 20. 211.5 x 109 / L, 1990 x 109 / L, 180 x 109 / L, 173 x 109 / L. 4 PLT can predict the stage of liver fibrosis in chronic liver disease.
【學(xué)位授予單位】：廣西醫(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

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