红细胞分布宽度与血小板计数比值在乙型肝炎肝硬化患者病情评估中的作用(1)
摘 要：目的 探討红细胞分布宽度与血小板计数比值在乙型肝炎肝硬化患者诊断及预后评估的关系。方法 选择2013年1月～2015年12月我院诊断为乙型肝炎肝硬化的患者144例、慢性乙型肝炎患者80例及同期健康体检者80例作为研究对象，收集其住院和(或)门诊检查资料，记录一般实验室检查结果，如血RDW、PLT、ALT、AST，计算基于血清学指标的模型，即RPR、APRI、FIB-4、Child-Pugh评分。相关性分析采用Spearman相关分析，绘制ROC曲线、计算AUC来判断RPR对肝硬化的预测价值。运用Kaplan-Meier法分析高RPR组与低RPR组乙型肝炎肝硬化患者3年生存率，同时将RPR、Child-Pugh评分纳入Cox回归分析，绘制54例乙型肝炎肝硬化死亡患者ROC曲线，判断RPR对乙型肝炎肝硬化患者预后的预测价值。结果 乙肝组、肝硬化组RPR分别为(0.33±0.16)Fl/(109/L)、(1.24±1.55)Fl/(109/L)，均高于健康体检组的(0.24±0.05)Fl/(109/L)，统计学意义显著(P<0.01)；肝硬化组RPR高于乙肝组，统计学意义显著(P<0.01)。RPR与乙型肝炎肝硬化呈正相关(r=0.66，P<0.01)。RPR预测乙型肝炎肝硬化的AUC为0.91，优于APRI，次于FIB-4，差异有统计学意义(P<0.05)。RPR、FIB-4、APRI诊断乙型肝炎肝硬化的最佳界值分别为0.43、3.00和0.79(P<0.01)，敏感度分别为84.00%、82.60%、84.00%，特异度分别为90.00%、95.00%和76.20%。RPR与Child-Pugh评分及MELD均呈正相关，r值分别为0.35、0.34(P<0.01)。高RPR组和低RPR组在随访3年期间生存率分别为56.80%和68.60%，差异无统计学意义(P>0.05)。结论 RPR可用于乙型肝炎肝硬化的诊断，RPR预测乙型肝炎肝硬化患者死亡的敏感性好，但特异性差，联合RPR可提高CP评分对乙肝肝硬化患者的预后评估效果。
, 百拇医药
关键词：乙型肝炎；肝硬化；红细胞分布宽度与血小板计数比值；Child-Pugh分级；终末期肝病模型
中图分类号：R575 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.20.019
文章编号：1006-1959(2018)20-0065-04
Abstract：Objective To investigate the relationship between red blood cell distribution width and platelet ratio in the diagnosis and prognosis evaluation of patients with hepatitis B cirrhosis.Methods From January 2013 to December 2015，144 patients with hepatitis B cirrhosis diagnosed in our hospital，80 patients with chronic hepatitis B and 80 healthy patients with physical examination were enrolled as study subjects，collect hospitalization and/or outpatient examination data，record general laboratory findings such as blood RDW，PLT，ALT，AST，and calculate models based on serological indicators，such as RPR，APRI，FIB-4，Child-Pugh scores.Correlation analysis using Spearman correlation analysis，drawing ROC curve，calculating AUC to judge the predictive value of RPR for cirrhosis. The Kaplan-Meier method was used to analyze the 3-year survival rate of patients with hepatitis B cirrhosis in the high RPR group and the low RPR group.The RPR and Child-Pugh scores were included in the Cox regression analysis to map the ROC curves of 54 patients with hepatitis B cirrhosis.To predict the predictive value of RPR for the prognosis of patients with hepatitis B cirrhosis. Results The RPR of the hepatitis B group and the cirrhosis group were(0.33±0.16)Fl/(109/L)and(1.24±1.55)Fl/(109/L)，respectively， which were higher than that of the healthy examination group(0.24±0.05)Fl/(109/L)，the difference was statistically significant(P<0.01)； the RPR of the cirrhosis group was higher than that of the hepatitis B group，the difference was statistically significant(P<0.01).RPR was positively correlated with hepatitis B cirrhosis(r=0.66，P<0.01).RPR predicts an AUC of 0.91 for hepatitis B cirrhosis，which is superior to APRI，which is second to FIB-4，the difference is statistically significant(P<0.05).The best cutoff values of RPR，FIB-4，and APRI for diagnosis of hepatitis B cirrhosis were 0.43，3.00，and 0.79，respectively(P<0.01)，and the sensitivity was 84.00%，82.60%，and 84.00%，respectively，and the specificity was 90.00%，95.00% and 76.20%.RPR was positively correlated with Child-Pugh score and MELD，and the r values were 0.35 and 0.34， respectively(P<0.01).The survival rates of the high RPR group and the low RPR group were 56.80% and 68.60%，respectively，during the 3-year follow-up period，the difference was not statistically significant(P>0.05).Conclusion RPR can be used for the diagnosis of hepatitis B cirrhosis.RPR predicts the sensitivity of death in patients with hepatitis B cirrhosis，but the specificity is poor.Combined with RPR can improve the prognosis of CP patients with hepatitis B cirrhosis., 百拇医药(桂志兵 汪文生)
, 百拇医药
关键词：乙型肝炎；肝硬化；红细胞分布宽度与血小板计数比值；Child-Pugh分级；终末期肝病模型
中图分类号：R575 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.20.019
文章编号：1006-1959(2018)20-0065-04
Abstract：Objective To investigate the relationship between red blood cell distribution width and platelet ratio in the diagnosis and prognosis evaluation of patients with hepatitis B cirrhosis.Methods From January 2013 to December 2015，144 patients with hepatitis B cirrhosis diagnosed in our hospital，80 patients with chronic hepatitis B and 80 healthy patients with physical examination were enrolled as study subjects，collect hospitalization and/or outpatient examination data，record general laboratory findings such as blood RDW，PLT，ALT，AST，and calculate models based on serological indicators，such as RPR，APRI，FIB-4，Child-Pugh scores.Correlation analysis using Spearman correlation analysis，drawing ROC curve，calculating AUC to judge the predictive value of RPR for cirrhosis. The Kaplan-Meier method was used to analyze the 3-year survival rate of patients with hepatitis B cirrhosis in the high RPR group and the low RPR group.The RPR and Child-Pugh scores were included in the Cox regression analysis to map the ROC curves of 54 patients with hepatitis B cirrhosis.To predict the predictive value of RPR for the prognosis of patients with hepatitis B cirrhosis. Results The RPR of the hepatitis B group and the cirrhosis group were(0.33±0.16)Fl/(109/L)and(1.24±1.55)Fl/(109/L)，respectively， which were higher than that of the healthy examination group(0.24±0.05)Fl/(109/L)，the difference was statistically significant(P<0.01)； the RPR of the cirrhosis group was higher than that of the hepatitis B group，the difference was statistically significant(P<0.01).RPR was positively correlated with hepatitis B cirrhosis(r=0.66，P<0.01).RPR predicts an AUC of 0.91 for hepatitis B cirrhosis，which is superior to APRI，which is second to FIB-4，the difference is statistically significant(P<0.05).The best cutoff values of RPR，FIB-4，and APRI for diagnosis of hepatitis B cirrhosis were 0.43，3.00，and 0.79，respectively(P<0.01)，and the sensitivity was 84.00%，82.60%，and 84.00%，respectively，and the specificity was 90.00%，95.00% and 76.20%.RPR was positively correlated with Child-Pugh score and MELD，and the r values were 0.35 and 0.34， respectively(P<0.01).The survival rates of the high RPR group and the low RPR group were 56.80% and 68.60%，respectively，during the 3-year follow-up period，the difference was not statistically significant(P>0.05).Conclusion RPR can be used for the diagnosis of hepatitis B cirrhosis.RPR predicts the sensitivity of death in patients with hepatitis B cirrhosis，but the specificity is poor.Combined with RPR can improve the prognosis of CP patients with hepatitis B cirrhosis., 百拇医药(桂志兵 汪文生)