无创肝脏炎症及纤维化评分系统对非酒精性脂肪性肝病并发肾损伤发病风险的预测价值

发布时间：2018-06-02 17:49

本文选题：非酒精性脂肪性肝病 + 慢性肾病　；参考：《吉林大学》2017年硕士论文

【摘要】：目的评价无创肝脏炎症及纤维化评分系统对NAFLD并发CKD的预测价值,找出对评价NAFLD并发CKD的最适合且最有价值的评分系统。方法2013年2月-2017年2月于吉林大学中日联谊医院消化内科门诊就诊或住院治疗并诊断为非酒精性脂肪性肝病的患者470例。参照2010年中华医学会肝病学分会《非酒精性脂肪性肝病诊疗指南》诊断策略中影像学诊断标准诊断为NAFLD,同时满足以下排除标准:(1)年龄小于20岁或大于80岁的患者;(2)NAFLD合并恶性肿瘤;(3)有肝内外胆道阻塞性疾病、胆道感染;(4)近3个月服用肝损伤或肾损伤药物;(5)存在肝损伤的代谢性疾病,包括Wilson病,血色病,痛风等;(6)严重心血管系统疾病,包括心肌梗死,心绞痛,心功能不全等;(7)妊娠或哺乳期妇女。根据患者血清生化分析,计算每个患者的eGFR,以eGFR60ml(/min/1.73 m2)定义为慢性肾病。根据eGFR将研究对象分为单纯NAFLD组及NAFLD合并CKD组。分别应用NFS、BARD、FIB-4及APRI四种无创肝脏炎症及纤维化评分系统对每个研究对象进行评分,计算不同评分系统预测NAFLD患者发生CKD的ROC曲线下面积,以面积0.70为有临床意义;同时对两组患者的一般特征进行比较分析,得出差异有统计学意义的相关指标;综合以上结果找出对NAFLD患者并发CKD发病风险预测价值最高的评分系统,对选出的评分系统进行多分类逻辑回归分析,排除相关混杂因素对实验结果的影响,发现NAFLD并发CKD的独立危险因素。结果1、NAFLD合并CKD组患者的年龄为(62.9±13.0)岁,明显大于单纯NAFLD组(51.1±13.2,p0.05),NAFLD合并CKD组糖尿病患者所占比例为40%,也明显高于单纯NAFLD组(13.6%,p0.05)。另外,NAFLD合并CKD组血清肌酐水平为(139.5±67.36)umol/L,明显高于单纯NAFLD组(74.8±13.9,p0.05)。此外,NAFLD合并CKD组肝脏酶学检查中的AST、GGT水平均高于单纯NAFLD组(p0.05)。2、四种无创评分系统预测NAFLD合并CKD的灵敏度均达到70%以上,其中以BARD评分系统最高,为86.77%。此外,四种评分系统对NAFLD合并CKD的阴性预测值均大于85%,其中也以BARD评分系统最高,为90.71%。但是,四种评分系统预测NAFLD合并CKD的特异度及阳性预测值较低,均在50%左右。四种无创评分系统中BARD系统预测NAFLD并发CKD的ROC曲线下面积最大为(0.711),其次为NFS(0.703),FIB-4(0.634),APRI(0.619)。3、通过调整年龄、性别、BMI、收缩压、舒张压、甘油三酯、总胆固醇等混杂因素的影响后,年龄及BARD评分仍可作为NAFLD并发CKD的独立预测因子。其中,BARD评分系统每增加1个单位的优势比OR值为2.82(p0.05)。此外,虽然NFS评分系统预测NAFLD并发CKD的ROC曲线下面积大于0.7(0.703),但通过调整相关混杂因素后,其每增加1个单位的优势比OR值为0.83(p0.05)。结论1、NAFLD患者无创肝脏炎症及纤维化评分系统评分的增高与CKD的发病风险升高密切相关;2、与其他系统相比,BARD是评价NAFLD合并CKD的最适合且最有价值的评分系统,并且具有较高的排除诊断价值。
[Abstract]:Objective to evaluate the predictive value of noninvasive hepatic inflammation and fibrosis scoring system for NAFLD complicated with CKD, and to find out the most suitable and valuable scoring system for evaluating NAFLD complicated with CKD. Methods from February 2013 to February 2017, 470 patients with non-alcoholic fatty liver disease were diagnosed as non-alcoholic fatty liver disease. Refer to the imaging diagnostic criteria in the diagnostic strategy of the 2010 Chinese Medical Association Hepatology Society "guidelines for the diagnosis and treatment of Non-alcoholic Fatty liver Disease", and meet the exclusion criterion: 1 / 1) for patients under 20 years of age or over 80 years of age NAFLD with malignant neoplasms 3) there are obstructive diseases of the biliary tract inside and outside the liver. The metabolic diseases of liver injury, including Wilson disease, hemochromatosis, gout, etc.) serious cardiovascular diseases, including myocardial infarction, angina pectoris, etc. Cardiac insufficiency 7) pregnant or lactating women. According to the serum biochemical analysis, eGFRs of each patient were calculated and defined as chronic nephropathy (eGFR60ml(/min/1.73 M2). According to eGFR, the subjects were divided into simple NAFLD group and NAFLD combined with CKD group. Four kinds of noninvasive liver inflammation and fibrosis scoring systems, NFS BARDI-4 and APRI, were used to evaluate the area under the ROC curve of CKD in patients with NAFLD. The area of 0.70 was of clinical significance. At the same time, the general characteristics of the two groups of patients were compared and analyzed, and the statistical significance of the relevant indicators were obtained. Combined with the above results, a scoring system with the highest predictive value for the risk of NAFLD patients complicated with CKD was found. Multiple logistic regression analysis was carried out on the selected scoring system, and the independent risk factors of NAFLD complicated with CKD were found by excluding the influence of related confounding factors on the experimental results. Results 1 the age of patients with NAFLD combined with CKD was 62.9 卤13.0 years old, which was significantly higher than that of patients with diabetes mellitus (51.1 卤13.2p0.05) in NAFLD group and CKD group, and it was also significantly higher than that in NAFLD group (13.6p 0.05). In addition, the serum creatinine level in NAFLD combined with CKD group was 139.5 卤67.36 渭 mol / L, which was significantly higher than that in simple NAFLD group (74.8 卤13.9 渭 g / L, P 0.05). In addition, the level of ASTGGT in liver enzymatic examination in NAFLD combined with CKD group was higher than that in NAFLD group. The sensitivity of the four noninvasive scoring systems for predicting NAFLD combined with CKD was over 70%, and the BARD scoring system was the highest (86.77). In addition, the negative predictive values of the four scoring systems for NAFLD with CKD were higher than 85g, among which the BARD scoring system was the highest (90.71%). However, the specificity and positive predictive value of NAFLD combined with CKD were lower (about 50%). Among the four noninvasive scoring systems, the BARD system predicted the maximum area under the ROC curve of NAFLD complicated with CKD, followed by NFS 0.703, FIB-4, 0.634, and 0.619. 3. After adjusting for age, sex, systolic blood pressure, diastolic blood pressure, triglyceride, total cholesterol, and so on, Age and BARD score can still be used as independent predictors of NAFLD complicated with CKD. The odds ratio (OR) of each additional unit in the BARD scoring system was 2.82% (P 0.05). In addition, although the area under the ROC curve of NAFLD complicated with CKD was predicted by NFS scoring system, the odds ratio (OR) of each additional unit was 0.83p0.05g after adjusting the relative confounding factors. Conclusion 1 the increased score of noninvasive hepatic inflammation and fibrosis in NAFLD patients is closely related to the increased risk of CKD. Compared with other systems, bard is the most suitable and valuable scoring system for the evaluation of NAFLD with CKD. And has the higher exclusion diagnosis value.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575;R692

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