探索血小板计数在慢性肝病中预测肝纤维化分期的价值

发布时间：2018-04-02 15:35

本文选题：肝纤维化　切入点：病理学　出处：《广西医科大学》2017年硕士论文

【摘要】：目的:研究血小板(platelet PLT)计数与慢性肝病肝脏纤维化分期的关系,探讨PLT计数在预测慢性肝病肝脏纤维化分期的价值。方法:采用回顾性分析,收集慢性肝病患者138例作为实验组。收集健康体检者414例作为对照组,收集实验组的年龄、性别、血常规、肝功能、肝穿刺活检组织,对照组年龄、性别、血常规。肝脏组织病理参照2000年西安全国病毒性肝炎及肝病学术会议修订的标准。比较实验组与对照组男女构成比、年龄、PLT计数的差异有无统计学意义。采用最优分箱方法进行数据预处理,绘制实验组肝纤维化分期与PLT计数受试者工作特征(ROC)曲线,选取诊断实验组肝纤维化分期敏感性及特异性近似70%时,实验组不同肝纤维化分期时对应PLT计数的截断值,并且与目前常用的APRI、FIB-4诊断模型比较特异性及敏感性。绘制实验组不同肝纤维化分期时与PLT计数的阶梯曲线。结果:(1)实验组与对照组年龄、性别构成比无差异(实验组:39.2±11.2岁,男105例,女性33例;对照组39.2±8.5岁,男321例,女性93例);实验组与对照组PLT计数存在差异(187.7±53.4X109/L比283.5±63.9X109/L,P0.01)(2)实验组中各纤维化分期的PLT计数分别为S0:214.0±24.8X109/L,S1:219.7±51.3X109/L,S2:191.5±48.9X109/L,S3:169.6±43.2X109/L,S4:148.6±44.5X109/L。进一步进行方差分析两两对比发现S4组与S0、S1、S2组、S1组与S3组PLT计数差异有统计学意义(P0.01),其余两组PLT计数之间比较差异无统计学意义(P0.05)。(3)实验组PLT计数181×109/L,肝脏组织病理≤S1(6例),≥S2(36例);PLT≥181×109/L,肝脏组织病理≤S1(56例),≥S2(40例)。(4)在实验组PLT计数与肝纤维化的ROC曲线上选取敏感性近似70%时的PLT计数截断值S1=211.5x109/L,S2=199x109/L,S3=180x109/L,S4=173x109/L。(5)在实验组PLT计数、APRI、FIB-4与肝纤维化的ROC曲线上敏感性近似70%时的特异性,S1(50%、50%、100%)、S2(69%、50%、69%)、S3(69%、63.2%、52.9%)、S4(69.4%、62.9%、54.1%)。结论:1、慢性肝病病人PLT计数比健康人PLT计数低。2、在慢性肝病病人中,PLT计数181x109/L时,90.3%的病人肝纤维化≥S2。3、PLT计数预测慢性肝病病人肝纤维化S1、S2、S3、S4敏感性近似70%时的截断值是:211.5x109/L、199x109/L、180x109/L、173x109/L。4、PLT计数可以初步预测慢性肝病肝纤维化分期。
[Abstract]:Aim: to study the relationship between platelet platelet PLT count and hepatic fibrosis stage of chronic liver disease, and to explore the value of PLT count in predicting hepatic fibrosis stage of chronic liver disease.Methods: 138 patients with chronic liver disease were collected as experimental group by retrospective analysis.The age, sex, blood routine, liver function, liver biopsy tissue, age, sex and blood routine of the experimental group were collected.Liver histopathology refers to the revised standards of Xi'an National Conference on viral Hepatitis and liver Diseases in 2000.The difference of age and PLT between the experimental group and the control group was statistically significant.The optimal box method was used to preprocess the data, and the curves of hepatic fibrosis stage and PLT counting were drawn. The sensitivity and specificity of hepatic fibrosis staging in the experimental group were approximately 70%, while the sensitivity and specificity of hepatic fibrosis staging in the experimental group were approximately 70%.In the experimental group, the truncation value of PLT count was corresponding to different stages of hepatic fibrosis, and the specificity and sensitivity of the experimental group were compared with the commonly used APRII-FIB-4 diagnostic model.The ladder curves of PLT count and different stages of hepatic fibrosis were plotted in the experimental group.Results there was no difference in age and sex ratio between experimental group and control group (experiment group: 39.2 卤11.2 years old, male 105 cases, female 33 cases, control group 39.2 卤8.5 years old, male 321 cases, control group 39.2 卤8.5 years old, male 321 cases).The sensitivity on the ROC curve is approximately 70. The sensitivity of S1 is about 50 and the sensitivity is about 50 and 50. The sensitivity of S1 is about 50. The sensitivity of S1 is about 50. The sensitivity of S1 is approximately 70. The sensitivity of S1 is approximately 70. The sensitivity of S1 is approximately 70. The sensitivity of S1 is approximately 70. The sensitivity of S1 is approximately 70. The sensitivity of S1 is approximately 70. The sensitivity of S1 is about 50.The PLT counts of 20. 211.5 x 109 / L, 1990 x 109 / L, 180 x 109 / L, 173 x 109 / L. 4 PLT can predict the stage of liver fibrosis in chronic liver disease.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2

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