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常用临床指标与慢乙肝肝硬化相关性分析论文

发布时间:2020-07-13 15:37:04 文章来源:SCI论文网 我要评论














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摘要:目的探讨常用临床指标与慢性乙型肝炎肝硬化的相关性。方法通过分析2017年9月至2019年3月潍坊医学院附属医院感染科84例确诊为慢乙肝肝硬化患者常用临床指标与CTP评分、meld评分的相关性,得出与肝硬化严重程度相关性指标。结果失代偿期组ALB,IBIL,GLB,DBIL,TBIL,INR,APTT,TT,PT,WBC,PLC-R,RDW-CV,RDW-SD,MPV,N,NLR明显高于代偿期组,且差异具有统计学意义(P<0.05),失代偿期组Na+,CHOL,HCT,L明显低于代偿期组,且差异具有统计学意义(P<0.05)。肝硬化患者APTT,TT,PLC-R,RDW-CV,RDW-SD,MPV,N,NLR与Child-Pugh、meld评分呈正相关,Na+,L呈负相关,具有统计学意义(P<0.05)。RDW-SD,NLR均可做为肝硬化失代偿期的独立危险因子。结论肝硬化患者RDW-SD,NLR与肝硬化相关,能进一步评价肝硬化患者病情和肝脏损害程度。

关键词:肝硬化;代偿期肝硬化;失代偿期肝硬化;临床指标;中性粒细胞/淋巴细胞比值;红细胞分布宽度

本文引用格式:李丹彤,戚丽,赵睿.常用临床指标与慢乙肝肝硬化相关性分析[J].世界最新医学信息文摘,2019,19(71):253-254.

Correlation Analysis between Common Clinical Indicators and Chronic Hepatitis B Cirrhosis

LI Dan-tong,QI Li,ZHAO Rui

(Department of infectious diseases,Weifang Medical college,Weifang Shandong)

ABSTRACT:Objective To explore the correlation between common clinical indicators and chronic hepatitis B cirrhosis.Methods The correlation between common clinical indicators and CTP score and meld score of 84 patients diagnosed with chronic hepatitis b cirrhosis in the infectious diseases department of affiliated hospital of weifang medical college from September 2017 to March 2019 was analyzed to obtain the correlation indicators with the severity of cirrhosis.Results Propagated decompensated liver cirrhosis group,IBIL,GLB,TBIL,DBIL,INR,APTT,TT,PT,the WBC,PLC-R,RDW-CV,RDW-SD,MPV,N,NLR is significantly higher than decompensated cirrhosis group,and the difference has statistical significance(P<0.05),decompensation period set of Na+,CHOL,HCT,L was lower than that in group compensatory period,and the difference has statistical significance(P<0.05).APTT,TT,plc-r,rdw-cv,rdw-sd,MPV,N,NLR were positively correlated with child-pugh and meld scores,while Na+and L were negatively correlated,showing statistical significance(P<0.05).RDW-SD and NLR are independent risk factors for decompensated cirrhosis.Conclusion RDW-SD and NLR in patients with cirrhosis are related to cirrhosis,and can further evaluate the condition and degree of liver damage in patients with cirrhosis.

KEY WORDS:Cirrhosis;Compensatory cirrhosis;Decompensated cirrhosis;Clinical indicators;Neutrophil/lymphocyte ratio;Erythrocyte distribution width

0引言

肝硬化作为各种肝病的终末期阶段,其发病率及死亡率均较高,多年来一直备受关注。经多年的研究,建立了多个模型评价肝硬化肝损伤程度,而Child-Turcotte-Pugh(CTP)及meld评分的准确性被普遍证实。近年来越来越多的研究证实,红细胞分布宽度、血小板参数、中性粒细胞/淋巴细胞等指标与肝脏疾病密切相关[1-3]。

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1资料与方法

1.1研究对象


收集确诊为乙肝肝硬化患者84例,肝硬化代偿期组44例,失代偿期组40例。排除肿瘤、急性感染等疾病。

1.2研究方法

入院当天抽取患者空腹血,检测血生化、血常规、凝血功能指标。

1.3统计学方法

采用SPSS 19.0软件对数据进行统计学分析。符合正态分布及非正态分布的计量资料组间比较分别采用独立样本t检验及Mann-Whitney U检验,采用spearman分析两变量之间的相关性。采用Logistic分析影响因素。

2结果

2.1肝硬化患者常用临床指标分析


将84例肝硬化患者分为代偿期组与失代偿期组,进行常用临床指标分析,结果与代偿期组相比,失代偿期组ALB,IBIL,GLB,DBIL,TBIL,INR,APTT,TT,PT,WBC,PLC-R,RDW-CV,RDW-SD,MPV,N,NLR指标明显升高,而Na+,CHOL,HCT,L指标明显降低,差异均具有统计学意义(P<0.05)。

2.2各指标与CTP评分及MELD评分的相关性分析

将代偿组与失代偿组具有明显差异的指标与CTP评分及MELD评分进行进一步相关性分析,结果APTT,TT,PLC-R,RDW-CV,RDW-SD,MPV,N,NLR指标与Child-Pugh、meld评分呈正相关,Na+,L指标呈负相关,具有统计学意义(P<0.05)。如表1。


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2.3肝硬化程度影响因素的logistic分析

将与CTP评分及MELD评分相关的指标进行logistic回归分析,结果RDW-SD及NLR对肝硬化代偿期与失代偿期的影响有统计学意义(P<0.05),如表2。

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3讨论

中性粒细胞/淋巴细胞(NLR)被认为是一种炎症指标,近年来研究表明,NLR可做为肝癌、急、慢性肝衰竭等肝病预后的独立预测因子。[4,5]肝硬化患者NLR异常其原因主要表现在:(1)中性粒细胞是人体内最早发生免疫反应的细胞,在乙肝肝硬化中起主要免疫作用。(2)肝脏的慢性炎症反应释放炎症因子,主要引起中性粒细胞的增高。(3)中性粒细胞的升高可抑制T细胞的作用并促进T细胞的消耗,从而降低淋巴细胞数量[6]。红细胞分布宽度(RDW)主要表示红细胞体积大小的变异系数,经研究证实,RDM不仅与肾脏、心血管、肠道、免疫性疾病相关,与肝脏疾病也密切相关。Huan Wang[7]及Hemant Goyal[8]等人研究证明RDW与原发性胆汁性肝硬化、肝细胞癌密切相关。乙肝肝硬RDW异常的原因主要有:(1)乙肝病毒的感染引起机体免疫应答,肝脏持续炎症反应,促进炎症因子的表达,炎症因子抑制红细胞成熟并诱导网织红细胞的增大,促进增大的网织红细胞进入外周血液中[9]。(2)肝硬化患者门静脉高压,引起脾功能亢进从而加速红细胞的破坏,进而刺激骨髓释放未成熟的网织红细胞,使外周血中RDW增加。(3)肝硬化患者长期处于营养不良状态,影响骨髓造血系统。(4)肝硬化患者免疫系统低下,引起病毒、细菌感染也会引起红细胞的异质性。(5)肝脏持续炎症释放的促炎因子抑制促红细胞生成素(EPO)生成,使异质红细胞增多[10]。

综上,本研究对肝硬化患者进行常用临床指标的检测,通过与CTP评分及meld评分的相关性分析及loistic回归分析,得出结论RDW及LNR均可做为评价肝脏损害程度的独立因素。

参考文献

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