本文選題：剪切波彈性成像 + 慢加急性肝衰竭�。� 參考：《中山大學(xué)學(xué)報(bào)(醫(yī)學(xué)科學(xué)版)》2017年05期

【摘要】：【目的】探討實(shí)時(shí)二維剪切波彈性成像(2D SWE)評(píng)估慢加急性乙型肝炎肝衰竭(ACLF-HBV)患者預(yù)后的臨床應(yīng)用價(jià)值。【方法】入組對(duì)象為2013年10月1日至2015年12月31日我院感染科確診的312例慢加急性乙型肝炎肝衰竭患者。觀察終點(diǎn)為90 d,根據(jù)臨床結(jié)局分為好轉(zhuǎn)組192例和惡化組120例。入組后3 d內(nèi),應(yīng)用2D SWE進(jìn)行肝臟硬度測(cè)量,收集患者血常規(guī)、凝血、生化等血清學(xué)指標(biāo),觀察患者肝實(shí)質(zhì)回聲均勻度、肝包膜光滑度、右肝厚度、膽囊壁厚度、脾臟指數(shù)、腹水指數(shù)、門靜脈主干內(nèi)徑、附臍靜脈是否重開,計(jì)算終末期肝病評(píng)分(MELD)、CTP評(píng)分(CTP)、皇家醫(yī)學(xué)院醫(yī)院評(píng)分(KCH),入組后每2-4周動(dòng)態(tài)檢測(cè)2D SWE,直至患者出院或死亡\肝移植。【結(jié)果】惡化組的2D SWE高于好轉(zhuǎn)組[(44.0±7.5)k Pa vs(36.8±10.3)k Pa,t=-6.5,P=0.000],39.2 k Pa可作為預(yù)后不良的閾值。2D SWE評(píng)估ACLF-HBV患者預(yù)后的受試者操作特征曲線下面積(AUROC)為0.73,預(yù)后效能高于KCH(AUROC:0.65,z=2.1,P=0.033)。動(dòng)態(tài)檢測(cè)2D SWE,好轉(zhuǎn)組維持在40 k Pa以下,惡化組則一直高于40 k Pa,并有升高趨勢(shì)�！窘Y(jié)論】2D SWE評(píng)估ACLF-HBV患者預(yù)后的準(zhǔn)確性較高,測(cè)值高于39.2 k Pa的患者預(yù)后較差,反之預(yù)后較好;動(dòng)態(tài)檢測(cè)2D SWE的變化對(duì)于ACLF-HBV患者的預(yù)后評(píng)估也有潛在價(jià)值。
[Abstract]:[objective] to evaluate the clinical value of 2D SWE in evaluating the prognosis of patients with chronic and acute hepatitis B liver failure (ACLF-HBV). [methods] the patients were selected from October 1, 2013 to December 31, 2015. 312 cases of chronic and acute hepatitis B liver failure were diagnosed. The observation end point was 90 days. According to the clinical outcome, 192 cases were divided into two groups: improvement group (192 cases) and worsening group (120 cases). Within 3 days after entering the group, the liver hardness was measured by 2D SWE, and the blood routine, coagulation, biochemical and other serological indexes were collected. The liver parenchyma echo uniformity, hepatic capsule smoothness, right liver thickness, gallbladder wall thickness, spleen index were observed. Ascites index, portal vein diameter, umbilical vein reopening, To calculate the end stage liver disease score (MELDD / CTP) and the Royal Medical College Hospital (RCMH), 2D SWE was measured dynamically every 2-4 weeks until the patient was discharged from hospital or died of liver transplantation. [results] 2D SWE in the worsening group was higher than that in the improved group [44.0 鹵7.5kPa vs(36.8 鹵10.3k Pat-6.5kPa 0.000] 39.2 KPA. The area under the operating characteristic curve was 0.73, which could be used as a threshold for poor prognosis. 2D SWE was more effective than KCHAUROC0.65% in evaluating the prognosis of ACLF-HBV patients. The dynamic detection of 2D SWE showed that the improvement group remained below 40 KPA, while the worsening group was higher than 40 KPA and had an increasing trend. [conclusion] 2D SWE is more accurate in evaluating the prognosis of ACLF-HBV patients, and the prognosis of the patients whose values are higher than 39.2 KPA is poor. On the contrary, the change of 2D SWE has potential value in evaluating the prognosis of ACLF-HBV patients.
【作者單位】： 中山大學(xué)附屬第三醫(yī)院超聲科;中山大學(xué)附屬第三醫(yī)院肝臟疾病研究重點(diǎn)實(shí)驗(yàn)室;中山大學(xué)附屬第三醫(yī)院感染科;中山大學(xué)附屬東華醫(yī)院超聲科;
【基金】：廣東省自然科學(xué)基金(2016A030313205,2015A030313172)
【分類號(hào)】：R445.1;R575.3

【相似文獻(xiàn)】

相關(guān)期刊論文 前1條

1 劉文艷;殷桂春;軋春梅;;慢加急性肝衰竭相關(guān)腦水腫的護(hù)理[J];內(nèi)蒙古中醫(yī)藥;2014年21期

相關(guān)會(huì)議論文 前1條

1 陳瑛;;慢加急性肝衰竭的臨床護(hù)理[A];2012年浙江省醫(yī)學(xué)會(huì)肝病、感染病學(xué)學(xué)術(shù)年會(huì)暨浙江省感染科醫(yī)師學(xué)術(shù)年會(huì)論文集[C];2012年

相關(guān)碩士學(xué)位論文 前1條

1 丁茹;膿毒癥與慢加急性肝衰竭相關(guān)性的臨床研究[D];上海交通大學(xué);2015年

，

本文編號(hào)：1776368