超声测量胆囊壁厚度在乙肝肝硬化患者肝功能评估中的应用价值

发布时间：2018-01-25 12:31

本文关键词： 肝硬化超声胆囊肝功能　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的本研究通过对超声测量的乙肝肝硬化患者胆囊壁厚度与腹水、“双边”征、生化指标、肝功能分级之间的比较分析,探讨胆囊壁厚度与乙肝肝硬化患者生化指标的相关关系、腹水与胆囊壁厚度之间的关系、胆囊壁是否呈“双边”增厚与胆囊壁厚度之间的关系、胆囊壁厚度与肝功能分级之间的关系、胆囊厚度与腹水之间的关系、胆囊壁厚度在肝功能分级的提示意义,从而综合评价乙肝肝硬化患者胆囊壁厚度在肝功能评估中的应用价值。研究方法选择于我院就诊以及明确诊断后于我院超声科进行消化系统超声检查随访肝脏情况的151乙肝肝硬化患者纳入本研究,分别收集纳入研究所内的乙肝肝硬化患者超声测量的胆囊壁厚度、超声探查的腹水情况与超声观察下胆囊壁增厚是否呈“双边”征情况,并记录该患者同一时期肝硬化相关的生化检查结果,分析胆囊壁厚度与各生化指标之间的相关关系。根据肝功能Child-Pugh分级标准对纳入研究的患者进行肝功能分级。分别就肝硬化患者是否有腹水、胆囊壁是否呈“双边”征及肝功能Child-Pugh分级进行分组比较分析,应用ROC曲线分析以上有差异组间胆囊壁厚的最佳截断值。结果151例乙肝肝硬化患者胆囊壁厚度与总蛋白、白蛋白、前白蛋白水平呈显著负相关(p0.001,p=0.007,p=0.001),余指标与胆囊壁厚度无明显相关关系。有、无腹水的两组患者之间胆囊壁厚度、总蛋白、白蛋白、前白蛋白、总胆红素、直接胆红素、间接胆红素、谷草转氨酶、总胆汁酸之间有统计学差异,余指标与担保厚度无明显相关关系;胆囊有无“双边”征的两组患者之间胆囊壁厚度、总蛋白、白蛋白之间有统计学差异,余指标无明显差异。肝功能分级A、B、C级三组患者之间胆囊壁厚度差异有统计学意义(F=11.208,p0.001),肝功能分级A级与B级、A级与C级患者间胆囊壁厚度差异有统计学意义(P=0.001、P0.001),肝功能分级B级与C级间没有统计学差异(P=0.098)。患者是否有腹水,是否有“双边”征组间胆囊壁厚度差异有统计学意义,ROC曲线计算胆囊壁厚度,取得截断值为0.59cm、0.58cm。肝功能分级A级与B+C级胆囊壁厚度做ROC曲线,取得截断值为0.62cm。结论超声测量乙肝肝硬化患者的胆囊壁厚度是一种简便、安全、无创检查新的手段,对乙肝肝硬化患者肝功能评估具有重要临床价值。在临床医师判断肝硬化患者病情方面有明显意义。对于超声医师来说,对随访的肝硬化的患者检查除了常规检查外有了明确的侧重点,使超声检查与临床医师对检查的要求紧密结合,取得更好的随访效果。意义能够更直观的理解肝硬化产生的并发症对身体带来的影响,积极配合医师采取的手段控制病情。
[Abstract]:Objective to compare and analyze the thickness of gallbladder wall and ascites, bilateral sign, biochemical index and liver function grade in patients with hepatitis B cirrhosis by ultrasonography. To explore the correlation between the thickness of gallbladder wall and biochemical indexes in patients with hepatitis B cirrhosis, the relationship between ascites and the thickness of gallbladder wall, and the relationship between bilaterally thickening of gallbladder wall and the thickness of gallbladder wall. The relationship between the thickness of the gallbladder wall and the grade of liver function, the relationship between the thickness of the gallbladder and ascites, and the significance of the thickness of the gallbladder wall in the grading of liver function. Therefore, the application value of gallbladder wall thickness in liver function evaluation in patients with hepatitis B cirrhosis was comprehensively evaluated. A total of 151 patients with hepatitis B cirrhosis were included in this study. The thickness of gallbladder wall, the ascites detected by ultrasonography and whether the gallbladder wall thickening was "bilateral" were collected from patients with cirrhosis of hepatitis B who were included in the study. The results of biochemical examination related to liver cirrhosis in the same period were recorded. To analyze the correlation between the thickness of gallbladder wall and the biochemical indexes. According to the liver function Child-Pugh classification standard, the liver function of the patients included in the study were graded. Whether the liver cirrhosis patients have ascites or not. Whether the gallbladder wall presented "bilateral" sign and Child-Pugh grade of liver function were compared and analyzed. ROC curve was used to analyze the best truncation value of gallbladder wall thickness among the above groups. Results the gallbladder wall thickness, total protein and albumin were measured in 151 patients with hepatitis B cirrhosis. The level of prealbumin was negatively correlated with the thickness of gallbladder wall. There were significant differences in gallbladder wall thickness, total protein, albumin, prealbumin, total bilirubin, direct bilirubin, indirect bilirubin, glutamic oxaloacetic transaminase and total bile acid between the two groups without ascites. There is no obvious correlation between residual index and guarantee thickness. There were significant differences in gallbladder wall thickness, total protein and albumin between the two groups with or without "bilateral" sign of gallbladder. The difference of gallbladder wall thickness between group C and group C was statistically significant. There was significant difference in the thickness of gallbladder wall between grade A and grade C patients. There was no statistical difference between the grade B and grade C of liver function. Whether the patients had ascites and whether there was a difference in the thickness of gallbladder wall between the two groups was statistically significant. The ROC curve was used to calculate the thickness of gallbladder wall, and the truncation value was 0.59 cm ~ (-1) 0.58 cm 路cm. The ROC curve was made for grade A and B ~ C of liver function grade. The truncation value was 0.62cm.Conclusion Ultrasound measurement of gallbladder wall thickness in patients with hepatitis B cirrhosis is a simple, safe and non-invasive method. It has important clinical value for the evaluation of liver function in patients with hepatitis B cirrhosis. It is significant for clinicians to judge the condition of patients with liver cirrhosis. The follow-up of patients with cirrhosis in addition to routine examination has a clear focus, so that ultrasound examination and clinicians to the requirements of the examination closely combined. The significance can understand more intuitively the influence of the complications of liver cirrhosis on the body, and actively cooperate with doctors to control the disease.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62;R575.2;R445.1

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