【摘要】：目的:探討瞬時(shí)彈性成像技術(shù)(FibroScan)聯(lián)合天冬氨酸氨基轉(zhuǎn)移酶和血小板比率指數(shù)(Aspartate aminotransferase-to-Platelet Ratio Index APRI)檢測(cè)肝硬化患者合并食管胃底靜脈曲張程度及破裂出血風(fēng)險(xiǎn)的相關(guān)性和診斷預(yù)測(cè)價(jià)值。方法:1.選取河南科技大學(xué)第三附屬醫(yī)院于2013.1.1-2015.10.1行胃鏡檢查的病毒性肝炎肝炎后肝硬化患者210例,病毒性肝炎肝炎后肝硬化的診斷全部符合2013年人民衛(wèi)生出版社出版的第八版《內(nèi)科學(xué)》教材肝硬化的診斷標(biāo)準(zhǔn);根據(jù)胃鏡檢查報(bào)告將210例病毒性肝炎肝硬化患者分為無(wú)、輕、中、重度食管胃底靜脈曲張組;食管胃底靜脈曲張(Esophagogastric Varices EGV)診斷標(biāo)準(zhǔn)全部符合由中華醫(yī)學(xué)會(huì)消化內(nèi)鏡分會(huì)EGV學(xué)組制定的《消化道靜脈曲張及出血的內(nèi)鏡診斷和治療規(guī)范試行方案(2009)》;同時(shí)將210例肝硬化患者根據(jù)2008年由中華醫(yī)學(xué)會(huì)肝病學(xué)分會(huì)、消化病學(xué)分會(huì)、消化內(nèi)鏡分會(huì)制定《肝硬化門(mén)靜脈高壓食管胃底靜脈曲張出血(Esophageal Varices Bleeding EVB)的防治指南》分為有食管胃底靜脈出血組(簡(jiǎn)稱有出血組)、無(wú)食管胃底靜脈出血組(簡(jiǎn)稱無(wú)出血組)。2.同時(shí)收集所有入組病人在行胃鏡檢查同一時(shí)期內(nèi)(3天內(nèi))所檢測(cè)的Fibro Scan彈性值、天冬氨酸氨基轉(zhuǎn)移酶(Aspartate aminotransferase AST)和血小板(Platelet PLT)的值,再計(jì)算出APRI值。3.采用SPSS22.0統(tǒng)計(jì)軟件,計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差((X|-)±S)描述,兩組定量資料的比較使用t檢驗(yàn),多組定量資料的比較經(jīng)正態(tài)性和方差齊性檢驗(yàn),方差齊采用單因素方差分析,方差不齊采用Kruskal—Wallis檢驗(yàn);相關(guān)性分析采用Spearman相關(guān)分析;以胃鏡檢查診斷結(jié)果為金標(biāo)準(zhǔn)繪制受試者工作特征曲線(Receiver Operating Characteristic Curve,簡(jiǎn)稱ROC曲線),選取最佳閾值即靈敏度和特異度之和最大值所對(duì)應(yīng)的值,根據(jù)ROC曲線下的面積(The Area Under The Receiver Operating Characteristic Curves AUC)評(píng)價(jià)其診斷結(jié)果的準(zhǔn)確性。結(jié)果:1.無(wú)、輕、中、重度食管靜脈曲張患者的平均肝硬度值(Liver Stiffness Measure LSM,即FibroScan彈性值)依次是(17.94±3.72)kPa、(21.69±6.17)kPa、(26.58±6.69)kPa、(30.63±7.94)kPa;APRI平均值依次是(1.40±0.5)、(1.81±0.58)、(2.5±0.62)、(3.53±1.0),四組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);輕度及以上食管胃底靜脈曲張患者的LSM、APRI、LSM+APRI的ROC曲線下面積分別是0.856、0.900、0.906,靈敏度分別是0.632、0.847、0.889;中度及以上食管胃底靜脈曲張患者的LSM、APRI、LSM+APRI的ROC曲線下面積分別是0.857、0.924、0.923,靈敏度分別是0.692、0.744、0.769;重度食管胃底靜脈曲張患者的LSM、APRI、LSM+APRI的ROC曲線下面積分別是0.801、0.903、0.901,靈敏度分別是0.833、0.867、0.783。2.無(wú)、有出血組患者的LSM平均值分別是(22.87±6.95)kPa、(28.49±9.46)kPa,APRI平均值分別是(2.13±1.01)、(2.99±1.11),二組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);有出血組肝硬化患者的LSM、APRI、LSM+APRI的AUC分別是0.669、0.727、0.722。3.LSM及APRI與胃鏡分期具有較好的正相關(guān)性,相關(guān)系數(shù)(rs)依次為0.637,0.754(P0.01)。結(jié)論:1.FibroScan聯(lián)合APRI對(duì)病毒性肝炎肝炎后肝硬化患者合并食管胃底靜脈曲張的程度存在有效的診斷和預(yù)測(cè)價(jià)值。2.FibroScan聯(lián)合APRI對(duì)病毒性肝炎肝炎后肝硬化患者合并食管胃底靜脈曲張破裂出血的風(fēng)險(xiǎn)存在有效的診斷和預(yù)測(cè)價(jià)值。
[Abstract]:Objective: To investigate the correlation and diagnostic value of transient elastography (FibroScan) combined with aspartate aminotransferase-to-platelet Ratio Index (APRI) in detecting the severity of esophagogastric varices and the risk of rupture and bleeding in cirrhotic patients. 210 patients with viral hepatitis and posthepatitic cirrhosis underwent gastroscopy in the Third Affiliated Hospital of Technical University from January 13 to October 2015. The diagnosis of viral hepatitis and posthepatitic cirrhosis conformed to the diagnostic criteria of liver cirrhosis published in the eighth edition of "Internal Medicine" textbook published by the People's Health Publishing House in 2013. Patients with inflammatory liver cirrhosis were divided into no, mild, moderate and severe esophagogastric varices group, and the diagnostic criteria of esophagogastric varices (EGV) were all in accordance with the trial protocol for endoscopic diagnosis and treatment of gastrointestinal varices and bleeding (2009) formulated by the EGV group of the Chinese Medical Association. Patients with liver cirrhosis were divided into two groups according to the "Guidelines for the Prevention and Treatment of Esophageal Varices Bleeding EVB" formulated by the Society of Hepatology, the Society of Digestive Diseases and the Branch of Digestive Endoscopy of the Chinese Medical Association in 2008. Meanwhile, the values of Fibro Scan elasticity, Aspartate aminotransferase AST and platelet PLT were collected from all patients during the same period (3 days) of gastroscopy, and then the APRI values were calculated. 3. SPSS22.0 statistical software was used to calculate the mean (+) standard deviation of measurement data. (X | -) + S) descriptions, the comparison of two groups of quantitative data using t test, the comparison of multiple groups of quantitative data by normal and variance homogeneity test, variance homogeneity using one-way ANOVA, variance heterogeneity using Kruskal-Wallis test; correlation analysis using Spearman correlation analysis; gastroscopy diagnosis results as the gold standard to draw the work of the subjects. Receiver Operating Characteristic Curve (ROC Curve) was used to evaluate the diagnostic accuracy according to the area under the ROC curve (The Area Under The Receiver Operating Characteristic Curves AUC). Liver stiffness measurement LSM (FibroScan elasticity) was 17.94 (+ 3.72) kPa, 21.69 (+ 6.17) kPa, 26.58 (+ 6.69) kPa, 30.63 (+ 7.94) kPa, and APRI was (1.40 (+ 0.5)), (1.81 (+ 0.58)), (2.5 (+ 0.62)), (3.53 (+ 1.0)) with significant difference among the four groups (P 0.05). The ROC curves of LSM, APRI, LSM + APRI were 0.856, 0.900, 0.906, and the sensitivity was 0.632, 0.847, 0.889, respectively. The ROC curves of LSM, APRI, LSM + APRI were 0.857, 0.924, 0.923, 0.692, 0.744, 0.769 for moderate and above esophagogastric varices, respectively. The ROC curves of LSM, APRI and LSM+APRI were 0.801, 0.903 and 0.901, respectively, and the sensitivity was 0.833, 0.867 and 0.783.2. None. The mean LSM of patients with bleeding was (22.87 +6.95) kPa, (28.49 +9.46) kPa, and the mean APRI was (2.13 +1.01) and (2.99 +1.11), respectively. LSM, APRI, and LSM + APRI were 0.669, 0.727, 0.722.3. LSM and APRI were positively correlated with gastroscopic staging, and the correlation coefficients (rs) were 0.637, 0.754 (P 0.01). Conclusion: 1. FibroScan combined with APRI in patients with viral hepatitis cirrhosis complicated with esophageal and gastric varices. FibroScan combined with APRI has an effective diagnostic and predictive value for the risk of esophagogastric variceal bleeding in patients with post-viral hepatitis cirrhosis.
【學(xué)位授予單位】：河南科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R575.2

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