本文選題：肝硬化 + 慢性腎臟病��； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：目的 通過對(duì)比腎病低蛋白血癥及肝硬化低蛋白血癥在IMA及IMAR上有無差異，闡明這些提示白蛋白功能的指標(biāo)對(duì)肝硬化患者是否具有特異性；通過對(duì)肝硬化患者的研究論證其在評(píng)估肝硬化嚴(yán)重程度方面的價(jià)值及其與肝硬化病因之間的關(guān)系。 方法 2013年2月～2014年2月吉林大學(xué)中日聯(lián)誼醫(yī)院消化內(nèi)科住院的肝硬化患者及腎內(nèi)科住院的慢性腎臟病患者，，排除合并嚴(yán)重心血管疾病、血液及內(nèi)分泌系統(tǒng)疾病，病情尚未得到控制者；因原發(fā)性肝癌或其它惡性腫瘤導(dǎo)致的營(yíng)養(yǎng)不良狀態(tài)患者；合并缺血性疾病、氧化應(yīng)激狀態(tài)及酮癥酸中毒患者、合并急性腎損傷患者。對(duì)入組的低蛋白血癥組及非低蛋白血癥組患者均測(cè)定其ALT、AST、ALB、TBIL、DBIL、凝血酶原INR值、BUN、CREA、RBP、尿蛋白水平、IMA水平、計(jì)算IMAR（IMA/ALB）；病比較兩組患者間及不同亞組之間IMA及IMAR之間的差異；探討肝硬化患者IMA及IMAR與肝臟炎癥反應(yīng)指標(biāo)、肝臟合成、代謝、轉(zhuǎn)運(yùn)功能的相關(guān)指標(biāo)及腎功能指標(biāo)之間的關(guān)系，探討肝硬化患者IMA及IMAR水平與其Child-Pugh評(píng)分之間的相關(guān)性及其與肝硬化病因之間的關(guān)系。 結(jié)果 （1）低蛋白血癥組患者IMA及缺IMAR均明顯高于非低蛋白血癥組患者。 （2）低蛋白血癥組肝硬化合并腎損傷組患者IMA及IMAR較單純性腎臟病組均明顯升高，與單純性肝硬化組相比無明顯統(tǒng)計(jì)學(xué)差異。（3）非低蛋白血癥組三個(gè)亞組之間相比在IMA及IMAR的差異均無統(tǒng)計(jì)學(xué)意義。（4）肝硬化患者IMA及IMAR與患者的轉(zhuǎn)氨酶水平、肌酐、尿素氮、視黃醇結(jié)合蛋白及尿蛋白水平均無明顯相關(guān)性之間無明顯相關(guān)性，與膽紅素水平及凝血酶原INR值之間呈正相關(guān)。（5）IMA及IMAR與肝硬化患者Child Pugh評(píng)分均呈正相關(guān)。（6）不同病因肝硬化患者之間IMA及IMAR之間的關(guān)系均為酒精性肝硬化丙型肝炎肝硬化其他原因肝硬化乙型肝炎肝硬化。 結(jié)論 低蛋白血癥患者不僅白蛋白水平下降，白蛋白功能也明顯減低，非低蛋白血癥組患者白蛋白功能無明顯改變；肝硬化患者白蛋白功能明顯下降，而腎臟病患者白蛋白功能無明顯改變；肝硬化患者白蛋白功能與肝硬化嚴(yán)重程度相關(guān)，其Child-Pugh評(píng)分越高，白蛋白功能越差�；颊甙椎鞍坠δ芘c反映患者肝臟炎癥反應(yīng)程度的指標(biāo)、腎功能相關(guān)指標(biāo)之間無明顯關(guān)系，與反應(yīng)肝臟合成、代謝、轉(zhuǎn)運(yùn)功能的生化指標(biāo)膽紅素水平及凝血酶原INR值明顯相關(guān)，這些生化指標(biāo)越高，白蛋白功能越差；不同病因肝硬化患者之間白蛋白功能按依次遞減的順序?yàn)橐倚透窝赘斡不�、其他原因肝硬化、丙型肝炎肝硬化、酒精性肝硬化�?br/>[Abstract]:Objective to compare the difference of IMA and IMAR between hypoproteinemia of nephropathy and hypoproteinemia of liver cirrhosis, and to clarify whether these indicators of albumin function are specific to patients with liver cirrhosis. The value of liver cirrhosis in evaluating the severity of cirrhosis and its relationship with the etiology of cirrhosis were studied. Methods from February 2013 to February 2014, inpatients with liver cirrhosis and chronic kidney disease in Department of Digestive Medicine, Sino-Japanese Lianyi Hospital, Jilin University, were excluded from severe cardiovascular disease, blood and endocrine system diseases. Patients with uncontrolled condition; patients with malnutrition due to primary liver cancer or other malignant neoplasms; patients with ischemic diseases, oxidative stress and ketoacidosis; patients with acute renal injury. In the hypoproteinemia group and the non-hypoproteinemia group, the levels of alt, prothrombin INR, urinary protein and IMA were measured, and the difference of IMA and IMAR between the two groups were compared. To investigate the relationship between IMA and IMAR in patients with liver cirrhosis and the indexes of liver inflammation, liver synthesis, metabolism, transport function and renal function. To investigate the correlation between IMA and IMAR and Child-Pugh score and the relationship between IMA and IMAR and the etiology of cirrhosis. Results (1) IMA and IMAR in hypoproteinemia group were significantly higher than those in non-hypoproteinemia group. There was no significant difference in IMA and IMAR between the three subgroups of non-hypoproteinemia group and simple cirrhosis group. There was no significant correlation between retinol binding protein and urinary protein levels. A positive correlation was found between IMA and IMAR and Child's Pugh score in patients with liver cirrhosis. 6) the relationship between IMA and IMAR in patients with cirrhosis of different etiology was both alcoholic cirrhosis and hepatitis C liver. Cirrhosis of other causes Hepatitis B cirrhosis. Conclusion Albumin level and albumin function in patients with hypoproteinemia decreased significantly, while in patients with non-hypoproteinemia there was no significant change in albumin function, while in patients with cirrhosis, albumin function decreased significantly. The albumin function of patients with liver cirrhosis was correlated with the severity of cirrhosis, and the higher the Child-Pugh score, the worse the albumin function. There was no significant correlation between albumin function and the indexes reflecting the degree of inflammatory reaction in the liver, and there was no significant correlation between the serum albumin function and the related indexes of renal function, but the level of bilirubin and prothrombin INR were significantly correlated with the biochemical indexes of liver synthesis, metabolism and transport function. The higher these biochemical indexes were, the worse the albumin function was, and the decreasing order of albumin function among the patients with cirrhosis of different etiology was hepatitis B cirrhosis, other cirrhosis, hepatitis C cirrhosis and alcoholic cirrhosis.
【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】：2014
【分類號(hào)】：R575.2

【共引文獻(xiàn)】

相關(guān)期刊論文 前3條

1 胡德寶;莊利利;張日欣;張也;李鐘淑;方南洙;;WY14643對(duì)附植前小鼠胚胎體外發(fā)育及活性氧的影響[J];江蘇農(nóng)業(yè)學(xué)報(bào);2014年01期

2 任志明;周峰;楊海濤;;前列地爾對(duì)止血帶誘發(fā)的肺換氣功能損傷的影響[J];中國(guó)煤炭工業(yè)醫(yī)學(xué)雜志;2013年09期

3 胡德寶;張也;張日欣;張寶修;李鐘淑;方南洙;;WY14643對(duì)小鼠早期胚胎抗氧化損傷的影響[J];畜牧獸醫(yī)學(xué)報(bào);2014年04期

相關(guān)碩士學(xué)位論文 前1條

1 張正升;溫血停搏液持續(xù)灌注對(duì)心臟瓣膜置換術(shù)中缺血修飾白蛋白影響研究[D];鄭州大學(xué);2013年

本文編號(hào)：2025695