本文選題：慢性 + 乙型肝炎　； 參考：《新疆醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討HBV相關(guān)慢加急性肝衰竭患者外周血中皮質(zhì)醇的水平與病情嚴(yán)重程度及預(yù)后的關(guān)系。方法:入選2016年1月至2016年11月期間就診于新疆醫(yī)科大學(xué)第一附屬醫(yī)院感染性疾病中心30例HBV相關(guān)慢加急性肝衰竭患者,12例重度慢性乙型病毒性肝炎患者,同時選取20例健康對照組,分別檢測患者10:00、18:00、凌晨2:00三個時間段外周血皮質(zhì)醇濃度,同時檢測患者肝功能、凝血功能、肌酐等實驗室指標(biāo),比較各組間三個時間段皮質(zhì)醇濃度,并將皮質(zhì)醇與INR、PTA、TBiL、A ST、ALT、MELD評分進(jìn)行相關(guān)性分析。結(jié)果:HBV相關(guān)慢加急性肝衰竭組發(fā)生腎上腺皮質(zhì)功能不全約43%(13/30);HBV相關(guān)慢加急性肝衰竭組、重度慢性乙型病毒性肝炎組、健康正常組凌晨2:00外周血皮質(zhì)醇濃度分別為(161.32±104.18)nmol/L、(93.53±54.33)nmol/L、(19.06±8.11)nmol/L,呈逐漸遞減趨勢,三組間比較差異有統(tǒng)計學(xué)意義(F=20.65,P0.01);HBV相關(guān)慢加急性肝衰竭組凌晨2:00外周血皮質(zhì)醇濃度與PTA呈負(fù)相關(guān)(r=-0.383,P0.05),與INR(r=0.406,P0.05)、MEL D評分(r=0.421,P0.05)呈正相關(guān),與TBi L、AST、ALT無明顯相關(guān)性(P0.05)。HBV相關(guān)慢加急性肝衰竭死亡組凌晨2:00外周血皮質(zhì)醇濃度(205.43±110.62)nmo l/L明顯高于生存組外周血皮質(zhì)醇濃度(122.72±83.51)nmol/L,差異有統(tǒng)計學(xué)意義(t=2.33,P0.05);該ROC曲線下面積為0.763,有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:HBV相關(guān)慢加急性肝衰竭患者存在神經(jīng)-內(nèi)分泌-免疫系統(tǒng)變化,具有較高的腎上腺皮質(zhì)功能不全發(fā)生率。HBV相關(guān)慢加急性肝衰竭患者凌晨2:00外周血皮質(zhì)醇濃度明顯升高且與疾病嚴(yán)重程度以及患者預(yù)后有關(guān)。
[Abstract]:Objective: to investigate the relationship between the level of cortisol in peripheral blood and severity and prognosis of patients with HBV associated chronic and acute liver failure. Methods: from January 2016 to November 2016, 12 patients with severe chronic viral hepatitis B were enrolled in the infectious diseases center of the first affiliated Hospital of Xinjiang Medical University. At the same time, 20 cases of healthy control group were selected to detect the concentration of cortisol in peripheral blood at 10: 00, 18: 00, 2:00, and the laboratory indexes of liver function, coagulation function, creatinine and so on, and to compare the concentration of cortisol among the three time periods. The correlativity between cortisol and INRTAT TBiLA stoma meld score was analyzed. Results the adrenocortical dysfunction occurred in the group of chronic and acute hepatic failure associated with HBV-related and acute hepatic failure, and in the group of chronic hepatitis B, about 43% of the patients suffered from adrenocortical dysfunction. The concentrations of cortisol in normal group at 2:00 were 93.53 鹵54.33 nmol / L and 19.06 鹵8.11 nmol / L respectively, which showed a decreasing trend. There was a significant difference among the three groups. There was a positive correlation between the concentration of cortisol in peripheral blood and PTA at 2:00 in the group of HBV associated with HBV and acute liver failure, and with the score of R0.421P0.05 of INRRRRN 0.406P0.05Mel), which was negatively correlated with PTA at 2:00, and was positively correlated with the concentration of cortisol in patients with acute hepatic failure (AHF), and there was a positive correlation between the concentration of cortisol in peripheral blood and PTA, and the score of R0.421P0.05 in the patients with acute liver failure. There was no significant correlation between the concentration of cortisol in peripheral blood at 2:00 in the death group with acute liver failure and the level of cortisol in the patients with acute liver failure at 2:00, which was significantly higher than that in the survival group (122.72 鹵83.51 nmol / L), the difference was statistically significant (t 2.33, P 0.05), and the area under the ROC curve was 0.763with statistical significance. Conclusion there are neuroendocrine immune system changes in patients with chronic and acute hepatic failure associated with HBV. The incidence of adrenocortical dysfunction was higher in patients with chronic HBV-associated chronic and acute liver failure at 2:00 in the morning, and was related to the severity of the disease and the prognosis of the patients.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R512.62;R575.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 En-Qiang Chen;Fan Zeng;Ling-Yun Zhou;Hong Tang;;Early warning and clinical outcome prediction of acute-onchronic hepatitis B liver failure[J];World Journal of Gastroenterology;2015年42期

2 王貴強;王福生;成軍;任紅;莊輝;孫劍;李蘭娟;李杰;孟慶華;趙景民;段鐘平;侯金林;賈繼東;唐紅;盛吉芳;彭R，

本文編號：1994628