共查询到19条相似文献,搜索用时 83 毫秒
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Logistic回归分析评价血清免疫球蛋白预测乙型肝炎相关肝硬化 总被引:8,自引:0,他引:8
目的 探讨血清免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)对乙型肝炎相关肝硬化的诊断价值.方法 慢性乙型肝炎172例,其中病理诊断为肝硬化的患者28例,非肝硬化的患者144例.血清免疫球蛋白采用免疫透射比浊法测定.统计分析采用SPSS 12.0软件.肝硬化与非肝硬化患者之间血清IgG、IgA和IgM水平的比较采用两独市样本t检验;血清IgG、IgA和IgM水平诊断肝硬化的评价采用二分类Logistic回归分析.结果 肝硬化患荇血清IgG和IgA水平显著高于非肝硬化患者(t=4.702和3.034,P=0.000和0.003),血清IgM水平相近于非肝硬化患者(t=0.132,P=0.895).血清免疫球蛋白中,只有IgG符合Logistic回归分析纳入自变量标准(P<0.05).基于血清IgG建立的Logistic同归模型预测肝硬化的灵敏度、特异度、阻性预测值、阴性预测值、准确度分别为0.107、0.986,0.600、0.850、0.843.结论 血清IgG可作为预测乙型肝炎相关肝硬化的一项重要指标. 相似文献
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目的评价简易无创模型AAR ( AST-to-ALT ratio), APRI ( AST-to-platelet ratio index), SPRI ( spleen-to-platelet ratio index)API( age-platelet index) ,ASPRI( age-spleen-to-platelet ratio index)预测乙型肝炎相关肝硬化的临床价值。方法慢性乙型肝炎170例,其中病理诊断为非肝硬化138例,肝硬化32例。参照原始文献构建预测肝纤维化程度的简易无创模型。统计分析采用SPSS 13.0软件。简易无创模型在非肝硬化与肝硬化患者之间的比较采用两独立样本t检验。简易无创模型预测肝硬化的评价采用ROC曲线法。结果肝硬化患者的平均AAR、SPRI、API、ASPRI显著大于非肝硬化患者(P=0.000、0.009、0.000、0.005),平均APRI相近于非肝硬化患者(P=0.223)。AAR、APRI、SPRI、API、ASPRI预测肝硬化的ROC曲线下面积为0.81、0.62、0.71、0.73、0.74,均显著大于诊断参考下面积(P=0.000、0.033、0.000、0.000、0.000)。结论AAR、APRI、SPRI、API、ASPRI均有预测乙型肝炎相关肝硬化的价值;其中,AAR的实践效能最大,APRI实践效能最小。 相似文献
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目的 肝纤维化程度的评估对于指导慢性乙型肝炎患者治疗及预测预后具有重要意义,本研究旨在评价LPRI 评分对乙型肝炎肝纤维化/肝硬化初治人群的诊断价值。方法 筛选首都医科大学附属北京友谊医院既往乙型肝炎研究队列2013年6月—2015年9月经肝穿刺确诊的慢性乙型肝炎患者276例。基于患者肝脏硬度测定(LSM)联合PLT计算LPRI评分,以肝脏病理为金标准,评价LPRI评分对于乙型肝炎肝纤维化及肝硬化的诊断价值。不符合正态分布计量资料多组间比较采用Kruskal-Wallis H秩和检验,计数资料组间比较采用χ2检验。各诊断模型与肝穿病理的相关性分析采用Spearman相关分析;通过DeLong法比较多个无创诊断模型(LPRI、LSM、APRI、FIB-4)的受试者工作特征曲线下面积(AUC)及诊断性能。采用Bootstrap方法对LPRI肝纤维化/肝硬化的诊断价值进行内部验证。结果 根据肝纤维化程度的不同,分为F0/1组(n=63)、F2/3组(n=118)、F4组(n=95),3组间Alb、TBil、PLT、LSM、AFP及HBV DNA水平均具有统计学差异(P值... 相似文献
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乙型肝炎免疫球蛋白在乙型肝炎防治中的研究进展 总被引:15,自引:0,他引:15
自1977年乙型肝炎免疫球蛋白(HBIG)首次用于治疗HBsAg阳性患者后,HBIG作为被动免疫制剂被广泛应用于保护急性暴露或易受感染者、预防慢性乙型肝炎伴肝硬化行肝移植者术后乙型肝炎病毒(HBV)再感染,或作为联合被动主动免疫中的被动免疫制剂,用于保护HBsAg阳性母亲所生新生儿,阻断母婴传播。一、HBIG的应用(一)急性暴露者和易受感染者的应用早期报道,血液透析患者使用HBIG500U次,透析当日及间隔2个月共注射2次,其保护率高达80%。Palmovic[1]报道56例医护人员被意外HBsAg和(或)HBeAg污染针刺感染,3d内肌肉注射HBIG0.06ml kg,1个… 相似文献
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全世界每年有100万乙型肝炎病毒感染者死于其相关的肝硬化和肝癌,慢性乙型肝炎患者5年内有6%~20%开展至肝硬化,慢性乙型肝炎肝硬化的发生率、病情进展以及预后与血清HBVDNA水平密切相关,因此,对乙型肝炎相关肝硬化抗病毒治疗非常重要,需要引起足够的重视。 相似文献
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目的探讨检测慢性乙型肝炎、乙型肝炎肝硬化和乙型肝炎肝衰竭患者血清免疫球蛋白(Ig G、Ig M、Ig A)和补体C3、C4水平的意义。方法在32例慢性乙型肝炎、33例乙型肝炎肝硬化和35例乙型肝炎肝衰竭患者,采用速率散射免疫比浊法检测血清免疫球蛋白(Ig G、Ig M、Ig A)和补体C3、C4。结果乙型肝炎肝衰竭患者血清Ig A水平为(4.06±1.20)mg/L,显著高于慢性乙型肝炎[(3.18±1.23)mg/L,P0.05]和乙型肝炎肝硬化患者[(3.21±1.53)mg/L,P0.05];C3水平为(0.33±0.02)g/L,显著低于慢性乙型肝炎[(0.54±0.25)g/L,P0.05]和肝硬化患者[(0.60±0.05)g/L,P0.05];三组其他指标无显著性相差(P0.05)。结论血清Ig G、Ig M、Ig A和补体C3、C4水平检测对肝脏疾病的诊断有一定的临床意义。 相似文献
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目的观察HBeAg阳性慢性乙型肝炎和乙型肝炎肝硬化患者经替比夫定抗病毒治疗后血清免疫球蛋白IgG、IgA、IgM和补体C3、C4的变化,探讨替比夫定治疗对于患者体液免疫功能的影响。方法选择35例HBeAg阳性慢性乙型肝炎和22例乙型肝炎肝硬化患者,给予替比夫定抗病毒治疗,于治疗前和治疗后3个月、6个月,采用免疫透视比浊法检测血清免疫球蛋白IgG、IgA、IgM和补体C3、C4。结果在治疗前,慢性乙型肝炎患者血清IgG水平为(16.21±2.54) mg/L,显著低于肝硬化患者的[(19.42±2.95) mg/L,P<0.05];在治疗6个月时,肝硬化患者血清IgA水平为(1.41±0.18) mg/L,显著高于慢性乙型肝炎患者的[(1.26±0.17) mg/L,P<0.05];在其他各时间点比较,两组患者血清免疫球蛋白和补体水平无显著性相差(P>0.05)。结论HBeAg阳性慢性乙型肝炎和乙型肝炎肝硬化患者经替比夫定抗病毒治疗后机体体液免疫功能有一定程度的恢复。 相似文献
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目的 探讨使用彩色多普勒超声检查诊断乙型肝炎肝硬化的价值,为早期诊断提供实践经验。方法 2017年7月~2018年7月我院收治的乙型肝炎肝硬化患者80例和慢性乙型肝炎(CHB)患者50例,使用彩色多普勒超声检查,比较两组患者肝脏声像图特征、超声半定量评分和门静脉血流动力学相关指标。结果 肝硬化患者肝脏被膜、肝实质回声、肝内韧带、胆囊壁、脾脏面积、肝静脉清晰度和肝边缘形态彩色多普勒半定量评分分别为(4.1±1.1)、(2.5±0.5)、(1.5±0.2)、(2.7±0.3)、(2.6±0.6)、(2.7±0.4)和(2.3±0.3),显著高于CHB患者[分别为(1.4±0.3)、(1.4±0.3)、(1.0±0.1)、(1.2±0.2)、(1.3±0.3)、(1.2±0.1)和(1.0±0.3),P<0.05];肝硬化组门静脉内径为(1.5±0.1) cm,显著大于CHB组[(1.1±0.1) cm,P<0.05],血流速度为(12.6±1.3)cm/s,显著慢于CHB[(22.3±3.6)cm/s,P<0.05],血流量为(1114.4±117.4) ml/min,显著低于CHB[(1278.3±121.4) ml/min,P<0.05];以肝组织病理学检查为金标准,采用超声半定量评分>15分为截断点,其诊断肝硬化的灵敏度为93.8%,特异度为88.0%,阳性预测值为92.6%,阴性预测值为89.8%。结论 采用彩色多普勒超声检测并半定量评分肝脏和门静脉指标可有效诊断乙型肝炎肝硬化,临床应用价值较大。 相似文献
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AAR和API评估慢性乙型病毒性肝炎肝纤维化临床价值的比较 总被引:1,自引:0,他引:1
目的比较谷草转氨酶-谷丙转氨酶的比值(AAR)和年龄-血小板指数(API)对慢性乙型病毒性肝炎肝纤维化的临床价值。方法172例慢性乙型病毒性肝炎患者均接受肝组织病理检查,并同时检测肝功能和血常规,用ROC曲线评价AAR和API诊断慢性乙型病毒性肝炎肝纤维化的能力。结果肝纤维化S0、S1、S2、S3和S4的AAR无显著差异(P〉0.05),肝纤维化分期与AAR的相关系数(rs)=0.107(P〉0.05),ROC曲线分析显示AAR诊断显著肝纤维化和肝硬化的AUC均〈0.7;肝纤维化S4的API高于S0、S1、S2和s3(P〈0.01),肝纤维化分期与API的rs=0.314(P〈0.01),ROC曲线分析显示API诊断显著肝纤维化的AUC〈0.7(P〉0.05),但诊断肝硬化的AUC达到0.773(P〈0.01),敏感度(SN)达到70.83%,特异度(sP)达到72.18%。结论AAR对于评估慢性乙型病毒性肝炎肝纤维化的临床价值不大;API与肝纤维化分期有一定的相关性,可以用于肝纤维化S4的诊断,但对肝纤维化s1、s2和s3的区分能力有限。 相似文献
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Zhi-Qiao Zhang Li-Wen Huang Yong-Peng Chen Peng Wang 《Digestive and liver disease》2019,51(1):127-134
Background and aim
Fibrosis index based on the four factors (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) were not well validated in patients with chronic hepatitis B (CHB). The aim of this study was to validate the performances of these indexes and construct novel indexes for liver fibrosis assessment.Methods
A total of 1438 consecutive antivirus treatment-naïve patients with CHB were analysed, and two novel indexes (named HeBCI and HeBFI) were derived for cirrhosis and significant fibrosis detection.Results
For cirrhosis, the area under receiver operating characteristic curves (AUROCs) were 0.841 for HeBCI, 0.708 for FIB-4 and 0.623 for APRI in the model set, and 0.779, 0.690, 0.595 in the validation set. For significant fibrosis, the AUROCs were 0.781 for HeBFI, 0.693 for APRI and 0.641 for FIB-4 in the model set, and 0.776, 0.729, 0.641 in the validation set. HeBCI determined 750 (52.2%) patients as having cirrhosis or non-cirrhosis with an accuracy of 86%. HeBFI detected 673 (46.8%) patients with or without significant fibrosis with an accuracy of 76.6%.Conclusions
As economical and convenient indexes, HeBCI and HeBFI are suitable to serve as outpatient tools for detecting significant fibrosis and cirrhosis to reduce the need of liver biopsy significantly in resource-limited settings. 相似文献13.
F. Bortolotti M. Guido P. Cadrobbi C. Crivellaro S. Bartolacci M. Rugge A. Gatta 《Digestive and liver disease》2005,37(12):964-967
We reported two cases of hepatitis B virus infection-related cirrhosis developed during childhood and followed up for more than 20 years. Both the subjects remained untreated, and ultimately regression of cirrhosis was documented by clinical (including ultrasound) and histological examination. Recent studies have already suggested that hepatitis B virus-related cirrhosis may regress after treatment, but this is the first demonstration that hepatitis B virus-associated cirrhosis developed in childhood may be a spontaneously reversible process. Subsidence of virus replication and of necro-inflammatory process and the efficiency of liver regeneration and repair might contribute to this favourable outcome. 相似文献
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目的观察恩替卡韦治疗乙型肝炎肝硬化患者48周疗效。方法采用随机、对照队列研究方法,将98例乙型肝炎肝硬化患者分成三组,恩替卡韦(ETV)组32例,拉米夫定(LAM)组42例,对照组24例,采用常规保肝对症治疗,疗程均为48周。观察治疗不同时间点患者的病毒学、生化学、凝血酶原时间(PT)、肝纤维化指标及Child-Pugh计分等变化情况。结果 ETV组患者HBV DNA水平显著下降,由治疗前的(6.6±1.0)log10拷贝/ml分别降低为治疗后12周、24周和48周的(3.1±1.2)、(2.8±1.1)和(2.8±1.0)log10拷贝/ml,HBV DNA转阴率优于LAM组和对照组,12周、24周、48周时依次为(59.4%、31.0%、0.0%;84.4%、66.7%、0.0%;87.5%、69.0%、0.0%),差异均有统计学意义(P〈0.05)。在24和48周ETV组患者血清HBeAg阴转率及HBeAg/抗-HBe血清学转换率(47.6%,23.8%;52.4%,38.1%)与对照组(0.0%、0.0%;0.0%,0.0%)比较,差异有统计学意义(P〈0.05)。ALT、AST、TBil明显下降,肝纤维化指标改善,Child-Pugh计分下降,在24和48周,ETV组和LAM组较治疗前比较差异有统计学意义(P〈0.05)。结论 ETV治疗乙型肝炎肝硬化患者能有效、快速抑制病毒复制,改善肝功能、肝纤维化指标及Child-Pugh计分等。 相似文献
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Shi-Hao Xu Fang Wu Le-Hang Guo Wei-Bing Zhang Hui-Xiong Xu 《World journal of gastroenterology : WJG》2020,26(45):7204-7221
BACKGROUNDEsophageal varices (EV) are the most fatal complication of chronic hepatitis B (CHB) related cirrhosis. The prognosis is poor, especially after the first upper gastrointestinal hemorrhage.AIMTo construct nomograms to predict the risk and severity of EV in patients with CHB related cirrhosis.METHODSBetween 2016 and 2018, the patients with CHB related cirrhosis were recruited and divided into a training or validation cohort at The First Affiliated Hospital of Wenzhou Medical University. Clinical and ultrasonic parameters that were closely related to EV risk and severity were screened out by univariate and multivariate logistic regression analyses, and integrated into two nomograms, respectively. Both nomograms were internally and externally validated by calibration, concordance index (C-index), receiver operating characteristic curve, and decision curve analyses (DCA).RESULTSA total of 307 patients with CHB related cirrhosis were recruited. The independent risk factors for EV included Child-Pugh class [odds ratio (OR) = 7.705, 95% confidence interval (CI) = 2.169-27.370, P = 0.002], platelet count (OR = 0.992, 95%CI = 0.984-1.000, P = 0.044), splenic portal index (SPI) (OR = 3.895, 95%CI = 1.630-9.308, P = 0.002), and liver fibrosis index (LFI) (OR = 3.603, 95%CI = 1.336-9.719, P = 0.011); those of EV severity included Child-Pugh class (OR = 5.436, 95%CI = 2.112-13.990, P < 0.001), mean portal vein velocity (OR = 1.479, 95%CI = 1.043-2.098, P = 0.028), portal vein diameter (OR = 1.397, 95%CI = 1.021-1.912, P = 0.037), SPI (OR = 1.463, 95%CI = 1.030-2.079, P = 0.034), and LFI (OR = 3.089, 95%CI = 1.442-6.617, P = 0.004). Two nomograms (predicting EV risk and severity, respectively) were well-calibrated and had a favorable discriminative ability, with C-indexes of 0.916 and 0.846 in the training cohort, respectively, higher than those of other predictive indexes, like LFI (C-indexes = 0.781 and 0.738), SPI (C-indexes = 0.805 and 0.714), ratio of platelet count to spleen diameter (PSR) (C-indexes = 0.822 and 0.726), King’s score (C-indexes = 0.694 and 0.609), and Lok index (C-indexes = 0.788 and 0.700). The areas under the curves (AUCs) of the two nomograms were 0.916 and 0.846 in the training cohort, respectively, higher than those of LFI (AUCs = 0.781 and 0.738), SPI (AUCs = 0.805 and 0.714), PSR (AUCs = 0.822 and 0.726), King’s score (AUCs = 0.694 and 0.609), and Lok index (AUCs = 0.788 and 0.700). Better net benefits were shown in the DCA. The results were validated in the validation cohort.CONCLUSIONNomograms incorporating clinical and ultrasonic variables are efficient in noninvasively predicting the risk and severity of EV. 相似文献
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目的研究首都医科大学附属北京地坛医院乙型肝炎肝硬化住院患者的并发症、合并症及死亡的相关危险因素。方法分别回顾性分析本院2008年1月至2010年12月2568例和2011年1月至2014年9月3008例乙型肝炎肝硬化住院患者的相关资料。结果发现乙型肝炎肝硬化并发症发病率最高为原发性肝癌,不同时期比较发现发病率呈上升趋势(P=0.000),其余并发症如腹水、上消化道出血、自发性细菌性腹膜炎、肝性脑病、肝肾综合征发病率呈下降趋势(P=0.000)。2型糖尿病、高血压等合并症发病率前后比较无统计学差异(P=0.399,P=0.089)。除自发性细菌性腹膜炎外,肺部感染是肝硬化住院患者最易发的感染。对不同时期死亡的相关危险因素进行多元回归分析,肝癌、自发性细菌性腹膜炎、肝性脑病、肝肾综合征和上消化道出血均与病死显著相关(P=0.000)。结论原发性肝癌仍然是乙型肝炎肝硬化最常见并发症,也是乙型肝炎肝硬化最主要的病死原因,病死患者均伴发多种并发症。 相似文献
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Pallavi Surana Julian Hercun Varun Takyar David E Kleiner Theo Heller Christopher Koh 《World journal of gastrointestinal pathophysiology》2021,12(3):40-50
BACKGROUND Simple tools for clinicians to identify cirrhosis in patients with chronic viral hepatitis are medically necessary for treatment initiation, hepatocellular cancer screening and additional medical management.AIM To determine whether platelets or other laboratory markers can be used as a simple method to identify the development of cirrhosis.METHODS Clinical, biochemical and histologic laboratory data from treatment naive chronic viral hepatitis B(HBV), C(HCV), and D(HDV) patients at the NIH Clinical Center from 1985-2019 were collected and subjects were randomly divided into training and validation cohorts. Laboratory markers were tested for their ability to identify cirrhosis(Ishak ≥ 5) using receiver operating characteristic curves and an optimal cut-off was calculated within the training cohort. The final cut-off was tested within the validation cohort.RESULTS Overall, 1027 subjects(HCV = 701, HBV = 240 and HDV = 86), 66% male, with mean(standard deviation) age of 45(11) years were evaluated. Within the training cohort(n = 715), platelets performed the best at identifying cirrhosis compared to other laboratory markers [Area Under the Receiver Operating Characteristics curve(AUROC) = 0.86(0.82-0.90)] and sensitivity 77%, specificity 83%, positive predictive value 44%, and negative predictive value 95%. All other tested markers had AUROCs ≤ 0.77. The optimal platelet cut-off for detecting cirrhosis in the training cohort was 143 × 109/L and it performed equally well in the validation cohort(n = 312) [AUROC = 0.85(0.76-0.94)].CONCLUSION The use of platelet counts should be considered to identify cirrhosis and ensure optimal care and management of patients with chronic viral hepatitis. 相似文献
18.
目的评价肝硬度(LS)联合APRI指数对慢性乙型肝炎肝纤维化的诊断价值。方法收集2009年8月-2013年1月本院收治的慢性乙型肝炎患者147例,按肝纤维化病理分期分组,利用声脉冲辐射力技术(ARFI)检测LS,并化验肝功能及血常规计算APRI指数。组间比较采用方差分析,采用Spearman相关性进行相关性检验。利用受试者工作特征曲线(ROC)分析LS对肝纤维化程度的诊断价值,并比较LS、APRI及两者联合诊断S≥1(存在肝纤维化)及S≥12(显著肝纤维化)的ROC曲线下面积。结果不同分组之间年龄、LS、AST、血小板(PLT)、APRI各组差异均有统计学意义(P〈0.05),Ls及APRI与病理分期具有良好的相关性,相关系数(rs)分别为0.793,0.699(P〈0.05);病理分期与AST,PLT的rs分别为0.292,-0.230(P〈0.05)。单独LS、APRI、联合Ls与APRI评价S≥1及S≥2的ROC曲线下面积分别为0.843、0.818、0.909和0.916、0.846、0.943;联合诊断ROC曲线下面积均大于单独LS或APRI诊断(P〈0.05)。结论LS联合APRI有助于提高早期肝纤维化程度的诊断。 相似文献
19.
目的观察恩替卡韦联合扶正化瘀胶囊治疗活动性肝硬化患者的疗效。方法60例活动性乙型肝炎肝硬化患者被随机分为观察组30例和对照组30例,两组均给予常规治疗。给予对照组患者恩替卡韦片治疗24 w,给予观察组患者恩替卡韦联合扶正化瘀胶囊治疗,观察并比较两组血清肝纤维化指标和肝功能变化。结果 治疗前对照组患者血清透明质酸为(320.4±196) ng/ml,层黏连蛋白为(180.9±80) ng/ml,Ⅲ型前胶胶原为(261.2±132) ng/ml、Ⅳ型胶原为(204.1±78.1) ng/m,谷丙转氨酶为(169.87±13.32) U/L、白蛋白为(34.05±6.94) U/L、总胆红素为(48.89±11.03) μmol/L,门静脉直径为(12.9±1.1)mm,脾脏长度为(12.9±1.1)mm、脾脏厚度为(48.6±4.7)mm,观察组透明质酸为(334.7±119.8) ng/ml,层黏连蛋白为(183.2±79.6) ng/ml,Ⅲ型前胶胶原为(252.5±139.8) ng/ml、Ⅳ型胶原为(203.3±74.1) ng/m,谷丙转氨酶为(171.53±11.21) U/L、白蛋白为(33.46±7.53) U/L、总胆红素为(49.33±10.1) μmol/L,门静脉直径为(13.1±0.7)mm,脾脏长度为(122.1±3.9)mm、脾脏厚度为(48.9±4.2)mm,两组无显著性统计学差异;治疗后,对照组透明质酸为(205.2±49.6) ng/ml,层黏连蛋白为(149.8±64.3) ng/ml,Ⅲ型前胶胶原为(192.7±99.8) ng/ml、Ⅳ型胶原为(159.2±42.5) ng/m,谷丙转氨酶为(54.89±6.65) U/L、白蛋白为(35.59±7.2) U/L、总胆红素为(20.89±9.65) μmol/L,门静脉直径为(11.7±0.85)mm,脾脏长度为(117.3±2.9)mm、脾脏厚度为(46.8±3.6)mm,观察组透明质酸为(158.2±79.1) ng/ml,层黏连蛋白为(104.3±59.7) ng/ml,Ⅲ型前胶胶原为(140.2±76.4) ng/ml、Ⅳ型胶原为(111.4±56.8) ng/m,谷丙转氨酶为(24.37±7.33) U/L、白蛋白为(41.02±6.3) U/L、总胆红素为(10.32±8.03) μmol/L,门静脉直径为(10.2±0.5)mm,脾脏长度为(109.4±3.1)mm、脾脏厚度为(44.4±2.0)mm,两组间具有显著性统计学差异(P<0.05);治疗48 结束时,观察组患者血清HBV DNA阴转率为83.3%,明显高于对照组治疗后的40%(P<0.05)。结论 恩替卡韦联合扶正化瘀胶囊治疗肝硬化患者,其疗效明显优于单用恩替卡韦。 相似文献