發(fā)布時(shí)間：2018-06-23 10:08

  本文選題：慢性丙型肝炎 + 肝纖維化�。� 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：研究目的:研究血清M2BPGi在直接抗病毒藥物(direct-acting antiviral agents,DAA)聯(lián)合聚乙二醇干擾素(pegylated interferon)(DAA+IFN)及直接抗病毒藥物(DAA)治療慢性丙型肝炎過程中的變化及差異,以及與其他生化指標(biāo)的相關(guān)性。研究方法:經(jīng)門診篩查符合入組條件的患者,參照《丙型肝炎防治指南(2015年更新版)》診斷標(biāo)準(zhǔn),明確診斷慢性丙型肝炎,并排除其他病毒感染、自身免疫性肝炎、藥物性肝損傷、酒精性肝炎、肝癌。入組患者簽訂知情同意書及自愿書;由臨床藥理基地醫(yī)生及護(hù)士定期向患者發(fā)放藥物及評(píng)估患者用藥情況;患者按實(shí)驗(yàn)設(shè)計(jì)按時(shí)服藥,與醫(yī)生約定時(shí)間定期回訪及復(fù)查�；颊哐Ｒ�(guī)、肝功能、肝纖維化掃描在隨訪時(shí)定期檢測,并留取樣本檢測治療過程中M2BPGi水平。通過SPSS軟件應(yīng)用獨(dú)立樣本mann-whitney U檢驗(yàn)、相關(guān)變量wilcoxon檢驗(yàn)和卡方檢驗(yàn)對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。研究結(jié)果:1、經(jīng)抗病毒治療達(dá)到持續(xù)性病毒學(xué)應(yīng)答后,DAA組與DAA+IFN組AST、ALT、APRI、M2BPGi的中位值均有所下降(p0.05),DAA組治療前后中位值分別為:AST50.39(16,119)、23.33(12,65),ALT 50.39(16,119)、20.2(9,93),APRI 0.931(0.17,4.96)、0.413(0.11,1.74),M2BPGi 2.472(0.43,12.96)、0.778(0.22,3.51);DAA+IFN組分別為:AST 48.44(19,106)、28.78(14,66),ALT 64.78(18,152)、18.94(0,61),APRI 0.734(0.20,1.86)、0.423(0.17,1.15),M2BPGi 1.525(0.59,4.13)、0.800(0.36,1.46);兩組下降的變化均具有統(tǒng)計(jì)學(xué)意義(p0.05)。2、DAA+IFN治療組與DAA治療組在治療結(jié)束時(shí)與基線水平的差值M2BPGi、ALB、PLT、APRI、FIB-4差異有統(tǒng)計(jì)學(xué)意義(p0.05),其中DAA+IFN組M2BPGi、APRI、FIB-4較基線時(shí)上升,而DAA組較基線時(shí)下降;AST、ALT、ALP兩組較基線時(shí)均有所下降,兩組之間無明顯統(tǒng)計(jì)學(xué)差異(p0.05)。達(dá)到病毒學(xué)應(yīng)答后12周后,DAA組M2BPGi、FIB-4下降程度較DAA+IFN組明顯(p0.05);AST、ALT、APRI兩組較基線時(shí)均有所下降,兩組之間無明顯統(tǒng)計(jì)學(xué)差異(p0.05)。3、DAA組血清M2BPGi水平整體基本均呈緩慢下降趨勢。DAA+IFN組血清中M2BPGi基本上均呈上升后下降的趨勢,大約在12周時(shí)達(dá)到最大值,停藥后快速下降。4、經(jīng)過單因素分析,血清M2BPGi水平與患者AST、ALT、APRI、FIB-4有相關(guān)性(P0.001),與纖維化評(píng)估指標(biāo)APRI、FIB-4相關(guān)性較強(qiáng),相關(guān)系數(shù)分別為0.546、0.528。經(jīng)線性回歸多因素分析,調(diào)整混雜因素后,AST(ES=-0.041,p0.009)、ALT(ES=-0.019,p0.003)是M2BPGi的獨(dú)立影響因素。對(duì)基線水平M2BPGi與Fibro Scan相關(guān)性分析,相關(guān)系數(shù)為r=0.685(p0.05)。結(jié)論:1、DAA治療組治療過程中血清M2BPGi整體呈緩慢下降趨勢;DAA+IFN治療組治療過程中血清M2BPGi整體上呈上升后下降趨勢;血清M2BPGi可能反映抗丙肝病毒過程中肝臟輕度炎癥變化。2、在達(dá)到持續(xù)性病毒學(xué)應(yīng)答后12周后,DAA治療組與DAA+IFN治療組APRI、M2BPGi的中位值均下降,可能反應(yīng)了治療后肝纖維化水平的好轉(zhuǎn)。兩組比較時(shí)M2BPGi下降值存在差異而APRI無明顯差異,可能說明M2BPGi較APRI更為敏感。
[Abstract]:Objective: to study the changes and differences of serum M2BPGi in the treatment of chronic hepatitis C with direct antiviral drugs (direct-acting antiviral agentsl) combined with polyethylene glycol interferon (pegylated interferon) (DAA) and direct antiviral drugs (DAA), as well as their correlation with other biochemical indexes. Methods: according to the guidelines for the prevention and treatment of hepatitis C (2015 update), the diagnosis criteria for chronic hepatitis C and other viral infections, autoimmune hepatitis, were clearly diagnosed, and other viral infections were excluded, according to the criteria of diagnosis and treatment of chronic hepatitis C, according to the guidelines for prevention and treatment of hepatitis C (updated in 2015). Drug induced liver injury, alcoholic hepatitis, liver cancer. The patients sign informed consent and voluntary letter of consent; doctors and nurses in clinical pharmacology base regularly distribute drugs to patients and evaluate the situation of patients; patients take drugs regularly according to experimental design, visit and review regularly with doctors. Blood routine examination, liver function, liver fibrosis scan were regularly detected during follow-up, and M _ 2 BPGI levels were detected during treatment. The data were analyzed by mann-whitney U test, wilcoxon test and chi-square test. 鐮旂┒緇撴灉:1,緇忔姉鐥呮瘨娌葷枟杈懼埌鎸佺畫鎬х梾姣掑搴旂瓟鍚，

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