红细胞分布宽度与血小板计数比值指数对评估非酒精性脂肪肝病肝纤维化的临床意义
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摘要
目的评估红细胞分布宽度与血小板计数比值指数在诊断监测非酒精性脂肪肝患者肝纤维化中的临床意义。方法选取2013—2017年延安大学附属医院男性非酒精性脂肪肝患者180例,女性非酒精性脂肪肝患者180例,慢性乙型病毒性肝炎患者60例,健康对照组60例,联合对研究对象进行血小板计数、红细胞分布宽度、谷丙转氨酶、谷草转氨酶、彩色腹部超声检测,检测结果通过公式计算出RPR指数、BMI指数,最后对实验数据进行统计学分析。结果非酒精性脂肪肝组RPR指数与慢性乙型病毒性肝炎组、健康对照组RPR指数之间差异有统计学意义(P <0.05),慢性乙型病毒性肝炎组、非酒精性脂肪肝组患者RPR指数均高于健康对照组。非酒精性脂肪肝患者不同性别组RPR指数之间差异有统计学意义,非酒精性脂肪肝男性组RPR指数高于女性组。非酒精性脂肪肝患者不同BMI分类组RPR指数之间差异有统计学意义,随着BMI升高,RPR指数也随之升高。非酒精性脂肪肝患者不同脂肪肝分度组RPR指数之间差异有统计学意义(P <0.05),随着脂肪肝分度的加深,RPR指数也随之升高。结论不同临床特征的非酒精性脂肪肝患者RPR指数之间存在差异性,男性、重度脂肪肝、BMI指数偏大的非酒精性脂肪肝患者,RPR指数有升高的趋势,由此推测RPR指数与非酒精性脂肪肝肝肝纤维化存在相关性。
Objective To assess the clinical significance of the ratio index of red cell distribution width to blood platelet count in the diagnosic and monitoring of liver fibrosis in patients with nonalcoholic fatty liver disease. Methods A total of180 male with nonalcoholic fatty liver disease,180 female outpatients with nonalcoholic fatty liver disease, and 60 patients with chronic viral hepatitis B and 60 healthy control group were selected from the Affiliated Hospital of Yan′an University in 2013-2017, the platelet count, red blood cell distribution width, alanine aminotransferase, aspartate aminotransferase, and color abdominal ultrasound were detected in the study. Then the RPR index and BMI index were calculated by the formula. Finally,the experimental data were statistically analyzed. Results There were statistical significance of RPR index among the patients with nonalcoholic fatty liver disease, chronic hepatic liver disease and the healthy control group, the RPR index of patients with chronic hepatitis B and nonalcoholic fatty liver was higher than that of healthy control group(P < 0.05). There were statistical significance of RPR index between the male and the female groups with nonalcoholic fatty liver disease,the RPR index of the male group was higher than that of the female group.There were statistical significance of RPR index among the different IBM index groups with nonalcoholic fatty liver disease,as the BMI increased,the RPR index also increased.There were statistical significance of RPR index among the different liver grade groups with nonalcoholic fatty liver disease(P < 0.05),as the fatty degree of liver increased, the RPR index also increased. Conclusion The RPR index of nonalcoholic fatty liver patients with different clinical characteristics were different, the RPR index have increased in male,severe fatty liver and large BMI index patients with nonalcoholic fatty liver,therefore it was speculated that the RPR index has the correlation with nonalcoholic fatty liverfibrosis.
Objective To assess the clinical significance of the ratio index of red cell distribution width to blood platelet count in the diagnosic and monitoring of liver fibrosis in patients with nonalcoholic fatty liver disease. Methods A total of180 male with nonalcoholic fatty liver disease,180 female outpatients with nonalcoholic fatty liver disease, and 60 patients with chronic viral hepatitis B and 60 healthy control group were selected from the Affiliated Hospital of Yan′an University in 2013-2017, the platelet count, red blood cell distribution width, alanine aminotransferase, aspartate aminotransferase, and color abdominal ultrasound were detected in the study. Then the RPR index and BMI index were calculated by the formula. Finally,the experimental data were statistically analyzed. Results There were statistical significance of RPR index among the patients with nonalcoholic fatty liver disease, chronic hepatic liver disease and the healthy control group, the RPR index of patients with chronic hepatitis B and nonalcoholic fatty liver was higher than that of healthy control group(P < 0.05). There were statistical significance of RPR index between the male and the female groups with nonalcoholic fatty liver disease,the RPR index of the male group was higher than that of the female group.There were statistical significance of RPR index among the different IBM index groups with nonalcoholic fatty liver disease,as the BMI increased,the RPR index also increased.There were statistical significance of RPR index among the different liver grade groups with nonalcoholic fatty liver disease(P < 0.05),as the fatty degree of liver increased, the RPR index also increased. Conclusion The RPR index of nonalcoholic fatty liver patients with different clinical characteristics were different, the RPR index have increased in male,severe fatty liver and large BMI index patients with nonalcoholic fatty liver,therefore it was speculated that the RPR index has the correlation with nonalcoholic fatty liverfibrosis.
引文
[1]YOUNOSSIZ M,KOENIGA B,ABDELATIF D,et al.Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence,incidence,and outcomes[J].Hepatology,2016,64(1):73-84.
[2]YE Z,SMITH C,KULLOI J.Usefulness of red cell distribution width to predict mortality in patients with peripheral artery disease[J].Am J Cardiol,2011,107(8):1241-1245.
[3]DURAN M,UYSALO K,GüNEBAKMAZ O,et al.Increased red cell distribution width level is associated with absence of coronary collateral vessels in patients with acute coronary syndromes[J].Turk Kardiyol Dern Ars,2013,41(5):399-405.
[4]UYAREL H,ERGELEN M,CICEK G,et al.Red cell distribution width as a novel prognostic marker in patients undergoing primary angioplasty for acute myocardial infarction[J].Coron Artery Dis,2011,22(3):138-144.
[5]YANGH J,LIU X,QU C,et al.Usefulness of red blood cell distribution width to predict heart failure hospitalization in patients with hypertrophic cardiomyopathy[J].Int Heart J,2018,59(4):779-785.
[6]DABBAH S,HAMMERMAN H,MARKIEWICZ W,et al.Relation between red cell distribution width and clinical outcomes after acute myocardial infarction[J].Am J Cardiol,2010,105(3):312-317.
[7]EKIZ F,YüKSEL O,KO?AK E,et al.Mean platelet volume as a fibrosis marker in patients with chronic hepatitis B[J].J Clin Lab Anal,2011,25(3):162-165.
[8]LIPPI G,TARGHER G,MONTAGNANA M,et al.Relationship between red blood cell distribution width and kidneyfunction tests in a large cohort of unselected outpatients[J].Scandinavian Journal of Clinical and Laboratory Investigation,2008,68(8):745-748.
[9]CHEN B D,YE B,ZHANG J,et al.RDW to platelet ratio:A novel noninvasive index for predicting hepatic fibrosis and cirrhosis in chronic hepatitis B[J].PLoS One,2013,8(7):e68780.
[10]CETINKAYA E,SENOL K,SAYLAM B,et al.Red cell distribution width to platelet ratio:New and promising prognostic marker in acute pancreatitis[J].World J Gastroenterol,2014,20(39):14450-14454.
[11]PUSUROGLU H,CAKMAKH A,AKGUL O,et al.The prognostic value of admission red cell distribution width-to-platelet ratio in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention[J].Rev Port Cardiol,2015,34(10):597-606.
[12]JIANG X H,WANG Y,SU Z Y,et al.Red blood cell distribution width to platelet ratio levels in assessment of histologic severity in patients with primary biliary cholangitis[J].Scand J Clin Lab Invest,2018,78(4):258-263.
[13]XIE S Y,CHEN X J.Red blood cell distribution width-to-platelet ratio as a disease activity-associated factor in systemic lupus erythematosus[J].Medicine(Baltimore),2018,97(39):e12342.
[14]KARAG?Z E,TANOGLU A,üL?AY A,et al.Mean platelet volume and red cell distribution width to platelet ratio for predicting the severity of hepatic fibrosis in patients with chronic hepatitis C[J].Eur J Gastroenterol Hepatol,2016,28(7):744-748.
[15]CHEN B D,YE B,ZHANG J,et al.RDW to platelet ratio:A novel noninvasive index for predicting hepatic fibrosis and cirrhosis in chronic hepatitis B[J].PLoS One,2013,8(7):e68780.
[16]HUANG R,WANG G Y,TIAN C,et al.Gamma-glutamyl-transpeptidase to platelet ratio is not superior to APRI,FIB-4 and RPR for diagnosing liver fibrosis in CHB patients in China[J].Sci Rep,2017,7(1):8543.
[17]FERDOUS A,AHMEDA N,RAHMANS A,et al.Role of red cell distribution width to platelet ratio in predicting hepatic fibrosis in chronic hepatitis B[J].Mymensingh Med J,2018,27(3):550-560.
[18]中华医学会肝病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病防治指南(2018更新版)[J].现代医药卫生,2018,34(5):641-649.
[19]中华医学会肝病学分会,脂肪肝和中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].中华流行病学杂志,2011,32(4):405-415.
[20]中华医学会肝病学分会脂肪肝和酒精性肝病学组.酒精性肝病诊疗指南(2010年1月修订)[J].中华内科杂志,2010,49(4):357-360.
[21]SAFIRI S,KHAZAEI S,MANSORI K,et al.Comments on“Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease:Systematic review and meta-analysis”[J].Hepatology,2017,66(4):1358-1359.
[22]CENGIZ M,OZENIRLER S.Comparative diagnostic accuracy of red cell distribution width-to-platelet ratio versus noninvasive fibrosis scores for the diagnosis of liver fibrosis in biopsy-proven nonalcoholic fatty liver disease[J].Eur J Gastroenterol Hepatol,2015,27(11):1293-1299.
[2]YE Z,SMITH C,KULLOI J.Usefulness of red cell distribution width to predict mortality in patients with peripheral artery disease[J].Am J Cardiol,2011,107(8):1241-1245.
[3]DURAN M,UYSALO K,GüNEBAKMAZ O,et al.Increased red cell distribution width level is associated with absence of coronary collateral vessels in patients with acute coronary syndromes[J].Turk Kardiyol Dern Ars,2013,41(5):399-405.
[4]UYAREL H,ERGELEN M,CICEK G,et al.Red cell distribution width as a novel prognostic marker in patients undergoing primary angioplasty for acute myocardial infarction[J].Coron Artery Dis,2011,22(3):138-144.
[5]YANGH J,LIU X,QU C,et al.Usefulness of red blood cell distribution width to predict heart failure hospitalization in patients with hypertrophic cardiomyopathy[J].Int Heart J,2018,59(4):779-785.
[6]DABBAH S,HAMMERMAN H,MARKIEWICZ W,et al.Relation between red cell distribution width and clinical outcomes after acute myocardial infarction[J].Am J Cardiol,2010,105(3):312-317.
[7]EKIZ F,YüKSEL O,KO?AK E,et al.Mean platelet volume as a fibrosis marker in patients with chronic hepatitis B[J].J Clin Lab Anal,2011,25(3):162-165.
[8]LIPPI G,TARGHER G,MONTAGNANA M,et al.Relationship between red blood cell distribution width and kidneyfunction tests in a large cohort of unselected outpatients[J].Scandinavian Journal of Clinical and Laboratory Investigation,2008,68(8):745-748.
[9]CHEN B D,YE B,ZHANG J,et al.RDW to platelet ratio:A novel noninvasive index for predicting hepatic fibrosis and cirrhosis in chronic hepatitis B[J].PLoS One,2013,8(7):e68780.
[10]CETINKAYA E,SENOL K,SAYLAM B,et al.Red cell distribution width to platelet ratio:New and promising prognostic marker in acute pancreatitis[J].World J Gastroenterol,2014,20(39):14450-14454.
[11]PUSUROGLU H,CAKMAKH A,AKGUL O,et al.The prognostic value of admission red cell distribution width-to-platelet ratio in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention[J].Rev Port Cardiol,2015,34(10):597-606.
[12]JIANG X H,WANG Y,SU Z Y,et al.Red blood cell distribution width to platelet ratio levels in assessment of histologic severity in patients with primary biliary cholangitis[J].Scand J Clin Lab Invest,2018,78(4):258-263.
[13]XIE S Y,CHEN X J.Red blood cell distribution width-to-platelet ratio as a disease activity-associated factor in systemic lupus erythematosus[J].Medicine(Baltimore),2018,97(39):e12342.
[14]KARAG?Z E,TANOGLU A,üL?AY A,et al.Mean platelet volume and red cell distribution width to platelet ratio for predicting the severity of hepatic fibrosis in patients with chronic hepatitis C[J].Eur J Gastroenterol Hepatol,2016,28(7):744-748.
[15]CHEN B D,YE B,ZHANG J,et al.RDW to platelet ratio:A novel noninvasive index for predicting hepatic fibrosis and cirrhosis in chronic hepatitis B[J].PLoS One,2013,8(7):e68780.
[16]HUANG R,WANG G Y,TIAN C,et al.Gamma-glutamyl-transpeptidase to platelet ratio is not superior to APRI,FIB-4 and RPR for diagnosing liver fibrosis in CHB patients in China[J].Sci Rep,2017,7(1):8543.
[17]FERDOUS A,AHMEDA N,RAHMANS A,et al.Role of red cell distribution width to platelet ratio in predicting hepatic fibrosis in chronic hepatitis B[J].Mymensingh Med J,2018,27(3):550-560.
[18]中华医学会肝病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病防治指南(2018更新版)[J].现代医药卫生,2018,34(5):641-649.
[19]中华医学会肝病学分会,脂肪肝和中华医学会感染病学分会.慢性乙型肝炎防治指南(2010年版)[J].中华流行病学杂志,2011,32(4):405-415.
[20]中华医学会肝病学分会脂肪肝和酒精性肝病学组.酒精性肝病诊疗指南(2010年1月修订)[J].中华内科杂志,2010,49(4):357-360.
[21]SAFIRI S,KHAZAEI S,MANSORI K,et al.Comments on“Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease:Systematic review and meta-analysis”[J].Hepatology,2017,66(4):1358-1359.
[22]CENGIZ M,OZENIRLER S.Comparative diagnostic accuracy of red cell distribution width-to-platelet ratio versus noninvasive fibrosis scores for the diagnosis of liver fibrosis in biopsy-proven nonalcoholic fatty liver disease[J].Eur J Gastroenterol Hepatol,2015,27(11):1293-1299.