非侵入性诊断方法对慢性乙型肝炎患者食管静脉曲张预测的回顾性研究

发布时间：2018-07-01 11:56

  本文选题：慢性乙型肝炎 + 食管静脉曲张　； 参考：《郑州大学》2017年硕士论文

【摘要】：背景我国是乙肝第一流行大国,很多患者最终都进入了肝功能衰竭的晚期肝硬化期,其中伴随着大量并发症。食管静脉曲张(Esophageal Varices,EV)是慢性乙肝肝硬化最常见的并发症,多突发大量呕血和(或)便血,常为大量出血,出现心慌、乏力、胸闷等全身症状,严重时引起出血性休克,诱发肝性脑病。EV破裂出血是肝硬化最常见、高死亡率的并发症,在第一次出血后,70%的患者会再次出血,故对EV的早期发现及治疗非常重要。临床上诊断EV广泛应用的诊断方法是上消化道内镜,内镜为侵入性诊断,极易出现操作过程中急性出血、麻醉意外等并发症,且病人较难耐受。无创血清学模型是血常规、肝功能、凝血四项检查所得指标通过相关公式建议起来的模型,近些年来备受关注,其中个别已被一些指南收录。瞬时弹性测定(Fibroscan,FS)是以超声为基础对肝纤维化进行测定,目前在临床上已广泛应用。目的比较无创血清学模型(AAR、APRI、GPRI、S index、API、Fibro-Q、King)和FS预测慢性乙型肝炎患者重度食管静脉曲张的诊断效能,探讨这些血清学模型与FS联合后的诊断价值。方法纳入慢性乙型肝炎患者140例,均行胃镜、血常规、肝功能、凝血四项检查(均为入院后2天内出血),计算出AST/ALT比值(AAR模型)、AST/PLT比值(APRI模型)、GGT/PLT比值(GPRI模型)、GGT-PLT-ASB比值(S-index模型)、与age-PLT相关的指数(API模型)、age-AST-INR-PLT-ALT相关的比值(Fibro-Q模型)、age-AST-INR-PLT相关的比值(King模型),利用瞬时弹性测定(FS)对纳入者肝脏硬度进行测量,EV以内镜诊断为金标准,应用这些数据建立模型进行回顾性研究,数据分析采用受试者工作曲线。结果AAR、GPRI、S-index、APRI、API、Fibro-Q、King、FS预测重度食管静脉曲张的ROC曲线下面积分别为0.430、0.800、0.801、0.777、0.612、0.750、0.804、0.890。其中GPRI、S-index、King、FS预测EV的价值较AAR、APRI、API、Fibro-Q更为显著,而其敏感度、特异度分别为0.805、0.586,0.878、0.586,0.878、0.657,0.951、0.747。由此可见,FS敏感度、特异度均较高,相关性较好,预测价值最佳。将FS与GPRI、S-index、King两两联合后曲线下面积分别为:0.899(P0.01)、0.892(P0.01)、0.891(P0.01),与单独应用GPRI、S-index、King相比差异均有统计学意义。结论这些无创检查中,GPRI、S-index、King、Fibroscan对重度食管静脉曲张预测具有很好的诊断准确性,Fibroscan的诊断价值最好,GPRI、S-index、King较FS稍差,而APRI、API、Fibro-Q对重度食管静脉曲张预测价值一般,AAR未发现有明显诊断价值;Fibroscan与GPRI、S-index、King两两联合要比单纯应用Fibroscan预测价值更高,可以作为内镜检查的良好补充和替代方案。
[Abstract]:Background China is the first country of hepatitis B epidemic, many patients have finally entered the stage of liver failure of advanced cirrhosis, which accompanied by a large number of complications. Esophageal varices-EV is the most common complication of chronic hepatitis B cirrhosis. Induced hepatic encephalopathy bleeding is the most common complication of cirrhosis with high mortality. 70% of the patients will bleed again after the first hemorrhage, so it is very important for the early detection and treatment of EV. The clinical diagnosis of EV is widely used by endoscopy of upper digestive tract, which is an invasive diagnosis. It is easy to occur complications such as acute bleeding and anaesthesia accident in the course of operation, and the patients are difficult to tolerate. Non-invasive serological model is a model suggested by four indexes of blood routine, liver function and coagulation through relevant formulas, which has attracted much attention in recent years, some of which have been included in some guidelines. Transient elastic measurement (FibroscanFS), which is based on ultrasound, has been widely used in clinical practice. Objective to compare the diagnostic efficacy of noninvasive serological models (AARA APRIN GPRIS) and FS in predicting severe esophageal varices in patients with chronic hepatitis B (CHB), and to explore the diagnostic value of these serological models combined with FS. Methods 140 patients with chronic hepatitis B were treated with gastroscopy, blood routine examination and liver function. Four tests of coagulation (bleeding within 2 days after admission) were performed. The AST / alt ratio (AAR model) and the GGT / PLT / PLT ratio (GPRI model) were calculated. The age-AST-INR-PLT-associated ratio (Fibro-Q model) was calculated as the index (API model) associated with age-PLT (the ratio of age-AST-INR-PLT-ALT) and the age-AST-INR-PLT ratio (Fibro-Q model). Value (King model), using transient elastic measurement (FS) to measure the liver hardness of the participants and using endoscopic diagnosis as the gold standard. These data were used to establish a model for retrospective study, and the data were analyzed using the operating curve of subjects. Results the areas under the ROC curve for predicting severe esophageal varices with AARA GPRI S-index-APRI Fibro-QN KingFS were 0.430 ~ 0.800 ~ 0.801 ~ 0.7770.7012 ~ 0.750 ~ (0.804) ~ 0.890, respectively. The value of GPRI S-indexer KingFS in predicting EV was more significant than that in AARA APRI, and its sensitivity and specificity were 0.8050.586C 0.878N 0.878N 0.657N 0.951N 0.747, respectively. It can be seen that the sensitivity and specificity of FS are higher, the correlation is better, and the predictive value is the best. The area under the back curve of FS and GPRII-S-indexKing was 0.899 (P0.01), 0.892 (P0.01) and 0.891 (P0.01), respectively. There were significant differences between FS and GPRI S-indexKing alone. Conclusion Fibroscan has a good diagnostic accuracy in predicting severe esophageal varices. The diagnostic value of Fibroscan is better than that of FS. The predictive value of Fibro-Q for severe esophageal varices in APRII was generally not found to have significant diagnostic value. The combination of Fibroscan and GPRII-S-indexKing was more valuable than that of Fibroscan alone, and could be used as a good supplement and substitute for endoscopic examination.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2;R512.62
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本文编号：2087700