乙肝肝硬化患者D二聚体与FIB的变化及干细胞治疗后疗效观察

发布时间：2018-03-21 14:50

本文选题：D二聚体　切入点：纤维蛋白原　出处：《滨州医学院》2013年硕士论文　论文类型：学位论文

【摘要】：目的探讨乙肝肝硬化患者血清D二聚体(D-D)和血浆纤维蛋白原(FIB)的变化情况及临床意义；研究脐带间充质干细胞(UCMSC)治疗失代偿期乙肝肝硬化的早期疗效。方法第一部分：以乙肝肝硬化患者73例(Child A级27例,Child B级26例,ChildC级20例)为研究对象,同期健康体检者24例为对照组；分别检测其血清D-D、血浆FIB水平。比较两组D-D和FIB水平的差异及不同Child分级肝硬化患者D-D和FIB水平的差异。评价二者对乙肝肝硬化患者肝脏功能损伤程度的诊断价值。第二部分：研究纳入失代偿期乙肝肝硬化患者45例,所有患者均予内科综合治疗,其中行UCMSC治疗的19例为治疗组,未行UCMSC治疗的26例为对照组。通过比较两组患者第1,2,4,8,12周总胆红素(TBiL)下降值、白蛋白(Alb)升高值、PTA改善值来评价其早期疗效；通过生存曲线比较两组患者并发症的发生差异。结果 1、乙肝肝硬化组血清D-D和血浆FIB含量与正常对照组比较,差异均有统计学意义。乙肝肝硬化组Child三级之间血清D-D均有统计学差异；FIB含量Child A级、B级无统计学差异,Child A级、B级与Child C级有统计学差异。 2、治疗组和对照组两组Alb、PTA水平均较基线水平升高,TBiL水平均较基线水平下降；治疗组Alb升高值、PTA改善值、TBiL下降值均优于对照组；随访12周时,治疗组Child C级患者所占比例低于对照组；生存曲线提示,治疗组患者腹水、肝性脑病等阳性事件的累积发生率低于对照组,P=0.043。结论 1、血清D-D和血浆FIB水平与肝脏的损伤程度密切相关,检测二者水平有助于评估乙肝肝硬化患者的病情严重程度及指导治疗。 2、UCMSC治疗失代偿期乙肝肝硬化早期疗效较好,远期疗效需进一步观察。
[Abstract]:Purpose. To investigate the changes and clinical significance of serum D dimer D-D) and plasma fibrinogen (FB) in patients with hepatitis B cirrhosis, and to study the early therapeutic effect of UCM SCC on decompensated hepatitis B cirrhosis. Method. The first part: 73 patients with hepatitis B cirrhosis, 27 patients with Child B grade B and 20 patients with Child B grade C) were studied, and 24 healthy persons were taken as the control group in the same period. The serum D-D and plasma FIB levels were measured, the difference of D-D and FIB levels between the two groups and D-D and FIB levels in patients with liver cirrhosis with different Child grades were compared, and the diagnostic value of D-D and FIB in patients with hepatitis B cirrhosis was evaluated. The second part: the study included 45 patients with decompensated hepatitis B cirrhosis, all of whom were given comprehensive medical treatment, 19 of whom were treated with UCMSC as the treatment group. 26 cases without UCMSC were treated as control group. The early curative effect was evaluated by comparing the decreasing value of total bilirubin and the elevation of albumin Alb and the difference of complications between the two groups by survival curve. Results. 1. The levels of serum D-D and plasma FIB in patients with hepatitis B cirrhosis were compared with those in normal controls. There was no statistical difference in serum D-D content between three levels of Child in patients with hepatitis B cirrhosis. There was no statistical difference in serum D-D content between Child A class and B grade. There was statistical difference between Child C and Child A grade. 2. The levels of Alb in the treatment group and the control group were both higher than the baseline level and lower than the baseline level, and the improvement value of Alb in the treatment group was higher than that in the control group. At 12 weeks follow-up, the improvement value of Alb in the treatment group was higher than that in the control group. The survival curve indicated that the cumulative incidence of ascites and hepatic encephalopathy in the treatment group was lower than that in the control group. Conclusion. 1. The levels of serum D-D and plasma FIB were closely related to the degree of liver injury. 2 the early efficacy of UCMSC in the treatment of decompensated hepatitis B cirrhosis needs further observation.
【学位授予单位】：滨州医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R575.2;R512.62

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