血清学指标与增强CT评估肝硬化食管胃静脉曲张

发布时间：2018-03-06 18:15

本文选题：血清学指标　切入点：增强CT　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景及目的食管胃静脉曲张破裂出血是肝硬化患者的主要死因之一。UGE(upper gastrointestinal endoscopy,上消化道内镜)检查是EGV(esophagogastric varices,食管胃静脉曲张)的诊断金标准,但具有侵袭性。目前,已有很多研究探讨了非侵袭性指标评估EGV的准确性。本研究旨在了解非侵袭性指标中的血清学指标与增强CT评估肝硬化EGV的准确性。方法1.在Pub Med、EMBASE、CNKI和万方数据库中,检索关于血清学指标[包括APRI(aspartate aminotransferasetoplatelet ratio index,谷草转氨酶/血小板比值指数)、AAR(aspartate aminotransferasetoalanine aminotransferase ratio,谷草转氨酶-谷丙转氨酶比值)、FIB-4、FI、King、Lok、Forns和Fibro Index评分]预测肝硬化EGV的研究。计算其AUSROC(area under the summary receiver operating characteristic curves,拟合受试者工作特征曲线下面积)、敏感度、特异度、PLR(positive likelihood ratio,阳性似然比)、NLR(negative likelihood ratio,阴性似然比)和DOR(diagnostic odds ratio,诊断比值比)。用QUADAS(Quality Assessment of Diagnostic Accuracy Studies,诊断准确性研究质量评估)对纳入文献进行质量评估。2.该回顾性研究纳入了2012年1月至2014年6月连续入住我院且行UGE检查的肝硬化患者,评估血清学指标(包括APRI、AAR、FIB-4、Lok和Forns评分)预测EV(esophageal varices,食管静脉曲张)的准确性。计算AUC(area under curves,曲线下面积)、敏感度和特异度。根据UGIB(upper gastrointestinal bleeding,上消化道出血)史及脾切除/脾动脉栓塞史进行亚组分析。3.在Pub Med和EMBASE数据库中,检索关于增强CT(computed tomography,计算机断层扫描)诊断肝硬化EGV准确性的研究。计算AUSROC、敏感度、特异度、PLR、NLR和DOR。根据EGV位置、CT技术和研究设计进行亚组分析。应用QUADAS-2对纳入文献进行质量评估。4.该回顾性研究纳入2012年6月到2014年6月连续入住我院且行增强CT和UGE检查的肝硬化患者,评估增强CT诊断EV的准确性。两个观察者分别判断增强CT图像上有无EV并对其最大直径进行测量。计算AUC、敏感度和特异度。结果1.APRI、AAR、FIB-4、FI、King、Lok、Forns和Fibro Index评分各纳入了12、4、5、0、0、4、3和1项研究。APRI、AAR、FIB-4、Lok和Forns评分预测EGV的AUSROC分别为0.6774、0.7275、0.7755、0.7885和0.7517,预测高危EGV的AUSROC分别为0.7278、0.7448、0.7095、0.7264和0.653。FIB-4和Forns评分预测EGV时存在显著的阈值效应。APRI、AAR和Lok评分预测EGV的敏感度/特异度/PLR/NLR/DOR分别为0.6/0.67/1.77/0.58/3.13、0.64/0.63/1.97/0.54/4.18和0.74/0.68/2.34/0.4/5.76。APRI、AAR、FIB-4、Lok和Forns评分预测高危EGV的敏感度/特异度/PLR/NLR/DOR分别为0.65/0.66/2.15/0.47/4.97、0.68/0.58/2.07/0.54/3.93、0.62/0.64/2.02/0.56/3.57、0.78/0.63/2.09/0.37/5.55和0.65/0.61/1.62/0.59/2.75。2.共纳入650例完善血清学指标且行UGE检查的肝硬化患者。根据UGE检查结果,81.4%的患者有中-重度EV。在整体分析中,血清学指标预测中-重度EV和EV的AUC分别为0.506-0.6和0.539-0.612。在无UGIB史的亚组分析患者中,预测中-重度EV和EV的AUC分别为0.601-0.664和0.596-0.662。在无UGIB史及脾切除/脾动脉栓塞史的亚组分析患者中,预测中-重度EV和EV的AUC分别为0.627-0.69和0.607-0.692。3.共纳入17项用增强CT诊断肝硬化EGV的研究,总体研究质量中等。CT预测EGV和高危EGV的AUSROC分别为0.8975和0.9494。预测EGV和高危EGV的拟合敏感度/特异度/PLR/NLR/DOR分别为0.87/0.8/3.67/0.18/22.7和0.87/0.88/7.52/0.12/65.55。亚组分析中,根据EGV的位置,预测胃静脉曲张的AUSROC为0.9127,预测EV和高危EV的AUSROC为0.8958和0.9461。根据CT技术,MDCT(multi-detector CT,多排CT)预测EGV和高危EGV的AUSROC分别为0.9047和0.949,MDCT食管造影术预测EGV和高危EGV的AUSROC分别为0.8735和0.9664。在前瞻性研究的亚组分析中,预测EGV和高危EGV的AUSROC分别为0.9122和0.9507。4.共纳入52例行增强CT和UGE检查的肝硬化患者。根据UGE检查结果,13.5%的患者无EV,11.5%的患者存在轻度EV,75%的患者存在中-重度EV。增强CT预测EV的AUC为0.835,敏感度和特异度分别为95.56%和71.43%。增强CT预测中-重度EV的AUC为0.821。当临界值为3.9mm时,预测中-重度EV的敏感度和特异度分别为89.74%和69.23%。结论血清学指标预测肝硬化EGV有低-中度准确性,无法代替UGE检查;增强CT诊断肝硬化EGV有较高准确性,可将其应用于临床减少UGE的使用率。
[Abstract]:Background and objective esophageal variceal hemorrhage is one of the main causes of death in patients with liver cirrhosis (.UGE upper gastrointestinal endoscopy, upper gastrointestinal endoscopy examination (esophagogastric) is EGV varices, esophageal and gastric varices) diagnostic gold standard, but aggressive. At present, there has been a lot of research on the accuracy of non invasive evaluation index EGV this study aims to understand the serological indexes of non invasive index and enhance the accuracy of evaluation of CT EGV in patients with liver cirrhosis. Methods 1. in Pub Med, EMBASE, CNKI and Wanfang database, retrieval on serum indexes including APRI (aspartate aminotransferasetoplatelet ratio index, aspartate aminotransferase to platelet ratio index (aspartate), AAR aminotransferasetoalanine aminotransferase ratio, AST - ALT), FIB-4, FI, King, Lok, Forns and Fibro Index were predicted Study of hepatic cirrhosis and EGV. Calculate the AUSROC (area under the summary receiver operating area characteristic curves, fitting under the receiver operating characteristic curve), sensitivity, specificity, PLR (positive likelihood ratio, positive likelihood ratio (negative), NLR likelihood ratio, negative likelihood ratio (diagnostic) and DOR odds ratio, diagnosis the odds ratio (Quality). QUADAS Assessment of Diagnostic Accuracy Studies, the diagnosis accuracy of quality assessment) for the quality of the included studies evaluating.2. this retrospective study included in January 2012 to June 2014 in our hospital and underwent UGE examination in patients with liver cirrhosis, serological indicators (including APRI, AAR, FIB-4, Lok and Forns score) EV (esophageal varices, esophageal varices). The accuracy of the calculation of AUC (area under curves, the area under the curve), sensitivity and specificity. According to UGIB (upper Gastr Ointestinal bleeding, upper gastrointestinal bleeding history) and splenectomy / splenic artery embolization history of the subgroup analysis of.3. in Pub Med and EMBASE database, retrieval on enhanced CT (computed tomography, computed tomography) in diagnosis of liver cirrhosis. The accuracy of EGV calculation of AUSROC, sensitivity, specificity, PLR, NLR and DOR. according to the the location of the EGV and CT technology research and design of subgroup analysis. To evaluate the quality of.4. this retrospective study included in the June 2012 to June 2014 in our hospital and underwent enhanced CT and UGE examination in patients with liver cirrhosis by QUADAS-2 in literature, evaluate the diagnostic accuracy of CT EV enhanced. Two observers were judged on CT images with and without EV and the measurement of the largest diameter increased. Calculation of AUC, sensitivity and specificity. The results of 1.APRI, AAR, FIB-4, FI, King, Lok, Forns and Fibro Index 12,4,5,0,0,4,3 and the score of each included 1 studies.AP RI, AAR, FIB-4, Lok and Forns score in predicting EGV AUSROC were 0.6774,0.7275,0.7755,0.7885 and 0.7517, respectively. The AUSROC prediction of high risk EGV 0.7278,0.7448,0.7095,0.7264 and 0.653.FIB-4 EGV and Forns score to predict there is.APRI significant threshold effect, AAR and Lok scores predict EGV sensitivity / specificity of /PLR/NLR/DOR were 0.6/0.67/1.77/0.58/3.13,0.64/0.63/1.97/0.54/4.18 and 0.74/0.68/2.34/0.4/5.76.APRI, AAR FIB-4, Forns, Lok and EGV risk score to predict the sensitivity / specificity of /PLR/NLR/DOR were 0.65/0.66/2.15/0.47/4.97,0.68/0.58/ 2.07/0.54/3.93,0.62/0.64/2.02/0.56/3.57,0.78/0.63/2.09/0.37/5.55 and 0.65/0.61/1.62/0.59/2.75.2. included a total of 650 cases of patients with liver cirrhosis and improve serum index of UGE examination. According to the results of UGE examination, 81.4% patients with moderate to severe EV. in the overall analysis, serological indicators In severe EV and EV AUC were 0.506-0.6 and 0.539-0.612. in UGIB history of the subgroup analysis of patients, prediction of moderate and severe EV and EV AUC were 0.601-0.664 and 0.596-0.662. in UGIB history and splenectomy / splenic artery thrombosis subgroup analysis in patients with moderate to severe EV and forecast EV AUC were 0.627-0.69 and 0.607-0.692.3. included 17 items with enhanced CT diagnosis of liver cirrhosis EGV, the quality of the overall research medium.CT prediction fitting EGV and high risk EGV AUSROC 0.8975 and 0.9494. respectively to predict EGV and high risk EGV sensitivity / specificity of /PLR/NLR/DOR were 0.87 /0.8/3.67/0.18/22.7 and 0.87/0.88/7.52/0.12/65.55. subgroup analysis, according to EGV the location prediction of gastric varices was 0.9127 AUSROC, EV and EV AUSROC risk prediction is 0.8958 and 0.9461. based on CT technology, MDCT (multi-detector CT, CT EGV and multi row) prediction of high risk EGV AUSR OC were 0.9047 and 0.949, MDCT esophageal angiography predict EGV and high risk EGV AUSROC 0.8735 and 0.9664. respectively in the prospective study of the subgroup analysis, prediction of EGV and high risk EGV AUSROC 0.9122 and 0.9507.4. respectively were included 52 cases of enhanced CT and UGE examination in patients with liver cirrhosis. According to the results of UGE test, 13.5% the patients without EV, there were 11.5% patients with mild EV, 75% patients with moderate to severe EV. enhanced CT prediction of EV AUC was 0.835, sensitivity and specificity were 95.56% and 71.43%. enhanced CT in prediction of severe EV AUC 0.821. when the critical value is 3.9mm, the prediction of moderate and severe EV sensitive the degree and specificity of serological index 89.74% and 69.23%. conclusion predicting cirrhosis EGV has low to moderate accuracy, can replace the UGE examination; enhanced CT diagnosis of liver cirrhosis EGV has high accuracy, which can be applied to reduce the clinical UGE usage.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2

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