本文選題：非酒精性脂肪性肝病 + 慢性腎病��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的評(píng)價(jià)無(wú)創(chuàng)肝臟炎癥及纖維化評(píng)分系統(tǒng)對(duì)NAFLD并發(fā)CKD的預(yù)測(cè)價(jià)值,找出對(duì)評(píng)價(jià)NAFLD并發(fā)CKD的最適合且最有價(jià)值的評(píng)分系統(tǒng)。方法2013年2月-2017年2月于吉林大學(xué)中日聯(lián)誼醫(yī)院消化內(nèi)科門診就診或住院治療并診斷為非酒精性脂肪性肝病的患者470例。參照2010年中華醫(yī)學(xué)會(huì)肝病學(xué)分會(huì)《非酒精性脂肪性肝病診療指南》診斷策略中影像學(xué)診斷標(biāo)準(zhǔn)診斷為NAFLD,同時(shí)滿足以下排除標(biāo)準(zhǔn):(1)年齡小于20歲或大于80歲的患者;(2)NAFLD合并惡性腫瘤;(3)有肝內(nèi)外膽道阻塞性疾病、膽道感染;(4)近3個(gè)月服用肝損傷或腎損傷藥物;(5)存在肝損傷的代謝性疾病,包括Wilson病,血色病,痛風(fēng)等;(6)嚴(yán)重心血管系統(tǒng)疾病,包括心肌梗死,心絞痛,心功能不全等;(7)妊娠或哺乳期婦女。根據(jù)患者血清生化分析,計(jì)算每個(gè)患者的eGFR,以eGFR60ml(/min/1.73 m2)定義為慢性腎病。根據(jù)eGFR將研究對(duì)象分為單純NAFLD組及NAFLD合并CKD組。分別應(yīng)用NFS、BARD、FIB-4及APRI四種無(wú)創(chuàng)肝臟炎癥及纖維化評(píng)分系統(tǒng)對(duì)每個(gè)研究對(duì)象進(jìn)行評(píng)分,計(jì)算不同評(píng)分系統(tǒng)預(yù)測(cè)NAFLD患者發(fā)生CKD的ROC曲線下面積,以面積0.70為有臨床意義;同時(shí)對(duì)兩組患者的一般特征進(jìn)行比較分析,得出差異有統(tǒng)計(jì)學(xué)意義的相關(guān)指標(biāo);綜合以上結(jié)果找出對(duì)NAFLD患者并發(fā)CKD發(fā)病風(fēng)險(xiǎn)預(yù)測(cè)價(jià)值最高的評(píng)分系統(tǒng),對(duì)選出的評(píng)分系統(tǒng)進(jìn)行多分類邏輯回歸分析,排除相關(guān)混雜因素對(duì)實(shí)驗(yàn)結(jié)果的影響,發(fā)現(xiàn)NAFLD并發(fā)CKD的獨(dú)立危險(xiǎn)因素。結(jié)果1、NAFLD合并CKD組患者的年齡為(62.9±13.0)歲,明顯大于單純NAFLD組(51.1±13.2,p0.05),NAFLD合并CKD組糖尿病患者所占比例為40%,也明顯高于單純NAFLD組(13.6%,p0.05)。另外,NAFLD合并CKD組血清肌酐水平為(139.5±67.36)umol/L,明顯高于單純NAFLD組(74.8±13.9,p0.05)。此外,NAFLD合并CKD組肝臟酶學(xué)檢查中的AST、GGT水平均高于單純NAFLD組(p0.05)。2、四種無(wú)創(chuàng)評(píng)分系統(tǒng)預(yù)測(cè)NAFLD合并CKD的靈敏度均達(dá)到70%以上,其中以BARD評(píng)分系統(tǒng)最高,為86.77%。此外,四種評(píng)分系統(tǒng)對(duì)NAFLD合并CKD的陰性預(yù)測(cè)值均大于85%,其中也以BARD評(píng)分系統(tǒng)最高,為90.71%。但是,四種評(píng)分系統(tǒng)預(yù)測(cè)NAFLD合并CKD的特異度及陽(yáng)性預(yù)測(cè)值較低,均在50%左右。四種無(wú)創(chuàng)評(píng)分系統(tǒng)中BARD系統(tǒng)預(yù)測(cè)NAFLD并發(fā)CKD的ROC曲線下面積最大為(0.711),其次為NFS(0.703),FIB-4(0.634),APRI(0.619)。3、通過(guò)調(diào)整年齡、性別、BMI、收縮壓、舒張壓、甘油三酯、總膽固醇等混雜因素的影響后,年齡及BARD評(píng)分仍可作為NAFLD并發(fā)CKD的獨(dú)立預(yù)測(cè)因子。其中,BARD評(píng)分系統(tǒng)每增加1個(gè)單位的優(yōu)勢(shì)比OR值為2.82(p0.05)。此外,雖然NFS評(píng)分系統(tǒng)預(yù)測(cè)NAFLD并發(fā)CKD的ROC曲線下面積大于0.7(0.703),但通過(guò)調(diào)整相關(guān)混雜因素后,其每增加1個(gè)單位的優(yōu)勢(shì)比OR值為0.83(p0.05)。結(jié)論1、NAFLD患者無(wú)創(chuàng)肝臟炎癥及纖維化評(píng)分系統(tǒng)評(píng)分的增高與CKD的發(fā)病風(fēng)險(xiǎn)升高密切相關(guān);2、與其他系統(tǒng)相比,BARD是評(píng)價(jià)NAFLD合并CKD的最適合且最有價(jià)值的評(píng)分系統(tǒng),并且具有較高的排除診斷價(jià)值。
[Abstract]:Objective to evaluate the predictive value of noninvasive hepatic inflammation and fibrosis scoring system for NAFLD complicated with CKD, and to find out the most suitable and valuable scoring system for evaluating NAFLD complicated with CKD. Methods from February 2013 to February 2017, 470 patients with non-alcoholic fatty liver disease were diagnosed as non-alcoholic fatty liver disease. Refer to the imaging diagnostic criteria in the diagnostic strategy of the 2010 Chinese Medical Association Hepatology Society "guidelines for the diagnosis and treatment of Non-alcoholic Fatty liver Disease", and meet the exclusion criterion: 1 / 1) for patients under 20 years of age or over 80 years of age NAFLD with malignant neoplasms 3) there are obstructive diseases of the biliary tract inside and outside the liver. The metabolic diseases of liver injury, including Wilson disease, hemochromatosis, gout, etc.) serious cardiovascular diseases, including myocardial infarction, angina pectoris, etc. Cardiac insufficiency 7) pregnant or lactating women. According to the serum biochemical analysis, eGFRs of each patient were calculated and defined as chronic nephropathy (eGFR60ml(/min/1.73 M2). According to eGFR, the subjects were divided into simple NAFLD group and NAFLD combined with CKD group. Four kinds of noninvasive liver inflammation and fibrosis scoring systems, NFS BARDI-4 and APRI, were used to evaluate the area under the ROC curve of CKD in patients with NAFLD. The area of 0.70 was of clinical significance. At the same time, the general characteristics of the two groups of patients were compared and analyzed, and the statistical significance of the relevant indicators were obtained. Combined with the above results, a scoring system with the highest predictive value for the risk of NAFLD patients complicated with CKD was found. Multiple logistic regression analysis was carried out on the selected scoring system, and the independent risk factors of NAFLD complicated with CKD were found by excluding the influence of related confounding factors on the experimental results. Results 1 the age of patients with NAFLD combined with CKD was 62.9 鹵13.0 years old, which was significantly higher than that of patients with diabetes mellitus (51.1 鹵13.2p0.05) in NAFLD group and CKD group, and it was also significantly higher than that in NAFLD group (13.6p 0.05). In addition, the serum creatinine level in NAFLD combined with CKD group was 139.5 鹵67.36 渭 mol / L, which was significantly higher than that in simple NAFLD group (74.8 鹵13.9 渭 g / L, P 0.05). In addition, the level of ASTGGT in liver enzymatic examination in NAFLD combined with CKD group was higher than that in NAFLD group. The sensitivity of the four noninvasive scoring systems for predicting NAFLD combined with CKD was over 70%, and the BARD scoring system was the highest (86.77). In addition, the negative predictive values of the four scoring systems for NAFLD with CKD were higher than 85g, among which the BARD scoring system was the highest (90.71%). However, the specificity and positive predictive value of NAFLD combined with CKD were lower (about 50%). Among the four noninvasive scoring systems, the BARD system predicted the maximum area under the ROC curve of NAFLD complicated with CKD, followed by NFS 0.703, FIB-4, 0.634, and 0.619. 3. After adjusting for age, sex, systolic blood pressure, diastolic blood pressure, triglyceride, total cholesterol, and so on, Age and BARD score can still be used as independent predictors of NAFLD complicated with CKD. The odds ratio (OR) of each additional unit in the BARD scoring system was 2.82% (P 0.05). In addition, although the area under the ROC curve of NAFLD complicated with CKD was predicted by NFS scoring system, the odds ratio (OR) of each additional unit was 0.83p0.05g after adjusting the relative confounding factors. Conclusion 1 the increased score of noninvasive hepatic inflammation and fibrosis in NAFLD patients is closely related to the increased risk of CKD. Compared with other systems, bard is the most suitable and valuable scoring system for the evaluation of NAFLD with CKD. And has the higher exclusion diagnosis value.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R575;R692

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