發(fā)布時(shí)間：2018-04-04 23:15

  本文選題：肝炎　切入點(diǎn)：肝硬化　出處：《中國(guó)全科醫(yī)學(xué)》2015年22期

【摘要】：目的了解血清腹腔積液清蛋白梯度(SAAG)、門(mén)靜脈內(nèi)徑(PVD)及血小板計(jì)數(shù)與脾長(zhǎng)徑比值(Plt/S-D)聯(lián)合應(yīng)用對(duì)肝炎肝硬化患者并發(fā)食管胃底靜脈曲張破裂出血的預(yù)測(cè)價(jià)值。方法抽取2013年1—12月,在濰坊醫(yī)學(xué)院附屬濰坊市人民醫(yī)院接受住院治療的肝炎肝硬化患者50例。根據(jù)有無(wú)食管胃底靜脈曲張破裂出血,將其分為出血組(n=26)和非出血組(n=24)。比較并分析兩組SAAG、PVD及Plt/S-D,繪制SAAG、PVD、Plt/S-D及三者聯(lián)合應(yīng)用對(duì)肝炎肝硬化患者并發(fā)食管胃底靜脈曲張破裂出血預(yù)測(cè)的受試者工作特征(ROC)曲線(xiàn)。結(jié)果 (1)兩組SAAG、PVD及Plt/S-D比較,差異有統(tǒng)計(jì)學(xué)意義(P0.01);非條件Logistic回歸分析顯示,SAAG、PVD及Plt/S-D對(duì)肝炎肝硬化患者并發(fā)食管胃底靜脈曲張破裂出血的影響有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)SAAG、PVD、Plt/S-D對(duì)肝炎肝硬化患者并發(fā)食管胃底靜脈曲張破裂出血預(yù)測(cè)的ROC曲線(xiàn)下面積分別為0.74、0.81及0.67。SAAG取值為20.50 g/L時(shí),靈敏度為80.8%,特異度為58.3%;取值為20.10 g/L時(shí),靈敏度為65.4%,特異度為62.5%。PVD取值為13.50 mm時(shí),靈敏度為80.8%,特異度為66.3%;取值為14.25 mm時(shí),靈敏度為65.4%,特異度為83.3%。Plt/S-D取值為0.88×109個(gè)/mm時(shí),靈敏度為80.8%,特異度為66.7%;取值為0.97×109個(gè)/mm時(shí),靈敏度為65.4%,特異度為66.7%。(3)SAAG、PVD及Plt/S-D聯(lián)合應(yīng)用對(duì)肝炎肝硬化患者并發(fā)食管胃底靜脈曲張破裂出血預(yù)測(cè)的評(píng)分公式為:預(yù)測(cè)出血評(píng)分=SAAG×PVD÷Plt/S-D,ROC曲線(xiàn)下面積為0.91,取值為890.35時(shí)有最佳的靈敏度和特異度,分別為87.8%和90.7%。結(jié)論 SAAG、PVD及Plt/S-D是肝炎肝硬化患者并發(fā)食管胃底靜脈曲張破裂出血的影響因素,三項(xiàng)聯(lián)合應(yīng)用對(duì)肝炎肝硬化患者并發(fā)食管胃底靜脈曲張破裂出血的預(yù)測(cè)價(jià)值較高。
[Abstract]:Objective to investigate the predictive value of serum albumin gradients in peritoneal effusion, PVD (PVD) and platelet count / spleen length ratio (PLT / S-D) in patients with hepatitis cirrhosis complicated with esophageal and gastric variceal variceal bleeding.Methods from January to December 2013, 50 patients with liver cirrhosis received inpatient treatment in Weifang people's Hospital affiliated to Weifang Medical College.According to the bleeding of esophageal and gastric varices, the patients were divided into two groups: the bleeding group (n = 26) and the non-bleeding group (n = 24).To compare and analyze the two groups of PVD and PltP / S-D of SAAGN PVD and their combined application to predict the bleeding of esophageal varices and fundus varices in patients with hepatitis cirrhosis, and to draw the ROCcurves of the subjects who were used together to predict the bleeding of esophageal varices and fundus fundus varices in patients with hepatitis cirrhosis.Results 1) PVD and Plt/S-D were compared between the two groups.The results of non-conditional Logistic regression analysis showed that there was significant difference in the effect of PVD and Plt/S-D on the bleeding of esophageal and gastric varices in patients with hepatitis and cirrhosis.When the area under the ROC curve was 0.74 鹵0.81 and the 0.67.SAAG value was 20.50 g / L, the predicted area under the ROC curve of varicose rupture bleeding was 0.74% and 20.50 g / L, respectively.鐏墊晱搴︿負(fù)80.8%,鐗瑰紓搴︿負(fù)58.3%;鍙栧，

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