RPR在乙型肝炎性肝纤维化诊断和预测严重程度中应用价值的评价

发布时间：2018-06-23 01:01

本文选题：无创模型 + RPR　；参考：《浙江大学》2017年硕士论文

【摘要】：目的探讨基于临床常见血液学指标的肝纤维化无创预测模型RPR(RDW/PLT)在乙型肝炎性肝纤维化诊断和预测严重程度中应用价值的评价。方法回顾性分析2010年1月至2014年12月就诊于浙江大学附属第二医院,符合本次研究纳入标准并行经肝脏活组织检查的131例肝纤维化患者(肝纤维化组)、620例肝癌患者(肝癌组)、101例胆结石患者(胆结石组)、430例肝良性病变患者(肝良性病变组)。每个疾病组依据是否伴发乙型肝炎各再分2个组。收集所有入选患者的临床常用血液学指标ALB、ALT、AST、GGT、PLT、RDW、Tch及年龄,计算肝纤维化无创诊断模型RPR、FIB-4、APRI、Forns、S;spearman双变量相关分析各模型与各疾病组的相关性;ROC曲线分析比较RPR和其他4个无创模型对肝纤维化组的统计学诊断效能。并且对131例病理组织涂片优良的肝纤维化病例进行肝纤维化病理分级,计算比较RPR在肝纤维化分级各级中的相对危险度(OR),分析RPR预测肝纤维化严重程度的应用价值。结果RPR在肝纤维化组、肝癌组、胆结石组、肝良性病变组四组的组间差异有统计学意义,RPR仅与肝纤维化组的相关性分析有明显的统计学意义;FIB-4、APRI、Forns、S均在肝纤维化组、肝癌组、胆结石组、肝良性病变组四组间的组间差异有统计学意义,且仅与肝纤维化组的相关性分析有明显的统计学意义。在肝纤维化疾病组的乙肝组中,RPR与肝纤维化的相关性最高且为正相关(0.572,P0.05),其次为Forns(0.390,P0.05)和FIB-4(0.347,P0.05);在肝纤维化组的非乙肝组中,仅RPR与肝纤维化的相关性有统计学意义,也为正相关(0.320,P0.05)。诊断肝纤维化的ROC曲线分析显示,RPR在乙肝组和非乙肝组中AUC均高于其余无创诊断模型(0.844,0.668)。RPR值均随肝纤维化严重程度增加而增高。结论RPR是诊断乙肝性肝纤维化的有效指标,RPR对非乙肝性肝纤维化亦有一定的指示作用。RPR也可用于预测肝纤维化严重程度。RPR可作为乙肝性肝纤维化临床诊断与预测严重程度的有力补充。
[Abstract]:Objective to evaluate the value of RPR (RDW / PLT), a noninvasive predictive model of hepatic fibrosis based on common clinical hematological parameters, in the diagnosis and prediction of the severity of hepatitis B liver fibrosis. Methods from January 2010 to December 2014, a retrospective analysis was made in the second affiliated Hospital of Zhejiang University. 131 patients with hepatic fibrosis (liver fibrosis group) and 620 patients with liver cancer (liver cancer group) were enrolled in the study. There were 101 patients with cholelithiasis (gallstone group) and 430 patients with benign liver disease (benign liver disease group). Each disease group was divided into 2 groups according to whether it was associated with hepatitis B. To collect all the commonly used clinical hematological indexes of all the selected patients, and to collect the age and the age of the patients with GGTPLT, RDWN, Tch, and the age of all the patients who were enrolled in the study. A non-invasive diagnostic model of liver fibrosis, RPR-FIB-4APRIB-4APRI-1, Fornsberg Spearman Bivariate correlation Analysis, was used to analyze the correlation between RPR and various disease groups. The statistical diagnostic efficacy of RPR and other four non-invasive models for hepatic fibrosis was compared. The relative risk (OR) of RPR in hepatic fibrosis grade was calculated and compared, and the value of RPR in predicting the severity of hepatic fibrosis was analyzed. Results there were significant differences in RPR between the four groups: hepatic fibrosis group, liver cancer group, gallstone group and benign liver disease group. There was significant correlation between RPR and hepatic fibrosis group. There were significant differences between the four groups in gallstone group and benign liver disease group, and only the correlation analysis between the four groups and liver fibrosis group was statistically significant. In the liver fibrosis group, the correlation between RPR and hepatic fibrosis was the highest and positive (0.572P 0.05), followed by Forns (0.390%) and FIB-4 (0.347 0. 05), while in the non-hepatitis B group, only the correlation between RPR and hepatic fibrosis was statistically significant (0.320 P 0.05). The ROC curve analysis of liver fibrosis showed that the AUC value of RPR in hepatitis B group and non-hepatitis B group was higher than that in other noninvasive diagnostic models (0.844 卤0.668). The RPR value increased with the increase of liver fibrosis severity. Conclusion RPR is an effective index for the diagnosis of hepatitis B hepatic fibrosis. RPR can also be used to predict the severity of hepatic fibrosis. RPR can also be used as a clinical diagnosis and prediction of liver fibrosis. A degree of severity that is powerfully replenished.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62;R575.2;R446.1

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