發(fā)布時(shí)間：2018-01-06 00:02

  本文關(guān)鍵詞：長(zhǎng)春市2～14歲漢族健康兒童臨床常用肝功項(xiàng)目參考區(qū)間的建立　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 年齡 性別 肝功 兒童 參考區(qū)間

【摘要】：目的:參考區(qū)間是解釋檢驗(yàn)結(jié)果的基本尺度和依據(jù),其準(zhǔn)確性、適用性直接影響著疾病的診療效率。肝功檢驗(yàn)項(xiàng)目的參考區(qū)間則是肝臟疾病診斷和健康評(píng)估最基本的依據(jù)。兒童作為與成人不同的參考人群,在年齡、生長(zhǎng)發(fā)育、營(yíng)養(yǎng)狀態(tài)等因素上的差異造成其參考區(qū)間與成人不盡相同,因此有必要建立兒童肝功項(xiàng)目的參考區(qū)間。本研究旨在建立并驗(yàn)證長(zhǎng)春市漢族健康兒童臨床常用肝功項(xiàng)目的參考區(qū)間。方法:參考國際臨床化學(xué)與檢驗(yàn)醫(yī)學(xué)聯(lián)合會(huì)及美國臨床和實(shí)驗(yàn)室標(biāo)準(zhǔn)化研究院制定的參考區(qū)間指南,在長(zhǎng)春市某醫(yī)院體檢中心及某婦幼保健院選擇2~14歲健康個(gè)體作為研究對(duì)象,通過問卷調(diào)查和體格檢查,按照篩選標(biāo)準(zhǔn)選擇參考個(gè)體進(jìn)行標(biāo)本采集及檢測(cè),采用日立7600-210全自動(dòng)生化分析儀檢測(cè)漢族健康兒童的血清丙氨酸氨基轉(zhuǎn)移酶(ALT)、天門冬氨酸氨基轉(zhuǎn)移酶(AST)、γ-谷胺�；D(zhuǎn)肽酶(GGT)、堿性磷酸酶(ALP)、總蛋白(TP)、清蛋白(ALB)、總膽紅素(TBIL)、直接膽紅素(DBIL),試劑及標(biāo)準(zhǔn)品均采用上海科華生物工程股份有限公司產(chǎn)品。檢測(cè)得到的數(shù)據(jù)使用EXCEL、R語言3.0、SPSS 21.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)描述和分析。檢查并剔除離群值后,判斷數(shù)據(jù)是否服從正態(tài)分布,采用中間95%區(qū)間作為參考區(qū)間,非參數(shù)方法計(jì)算各實(shí)際參考樣本組參考值的2.5百分位數(shù)和97.5百分位數(shù),并計(jì)算各百分位數(shù)的90%置信區(qū)間。利用Z檢驗(yàn)確定性別、年齡分組后的組間有無統(tǒng)計(jì)上的顯著性差異從而獲得性別、年齡分層的參考區(qū)間。分別在長(zhǎng)春市不同區(qū)域的5家醫(yī)院臨床實(shí)驗(yàn)室對(duì)獲得的兒童參考區(qū)間進(jìn)行驗(yàn)證,繪制2~14歲兒童血清肝功隨年齡變化的趨勢(shì)圖,對(duì)血清肝功與年齡、性別的相關(guān)性進(jìn)行分析,將獲得的參考區(qū)間與國家行業(yè)標(biāo)準(zhǔn)及不同地區(qū)兒童參考區(qū)間的調(diào)查結(jié)果進(jìn)行比較。結(jié)果:本研究滿足試驗(yàn)標(biāo)準(zhǔn)的研究對(duì)象共1394名,均為漢族,其中男649名,女745名,男女比例1:1.15。本研究建立了長(zhǎng)春市2~14歲漢族健康兒童臨床常用肝功項(xiàng)目參考區(qū)間,結(jié)果顯示常用的肝功項(xiàng)目均有年齡差異,所有肝功項(xiàng)目均需要2個(gè)以上的年齡分組。酶類項(xiàng)目(ALT、AST、GGT、ALP)有性別差異。血清酶類水平在低年齡段無性別差異,高年齡段開始出現(xiàn)性別差異。而血清蛋白質(zhì)(TP、ALB)、膽紅素(TBIL、DBIL)水平在整個(gè)年齡段均無性別差異。2~14歲兒童不同的肝功項(xiàng)目隨年齡呈現(xiàn)不同的變化趨勢(shì)。2~14歲兒童TP、TBIL和DBIL水平隨年齡增加逐漸增高,而AST水平隨年齡增加明顯降低;ALT、GGT、ALP水平隨年齡的變化較復(fù)雜,11~14歲男孩ALT、GGT水平顯著增高,13~14歲女孩ALP水平顯著降低。ALT、AST、GGT、ALP、TP、ALB、TBIL、DBIL與年齡有明顯的相關(guān)性(P0.05),AST、GGT與性別有明顯的相關(guān)性,而TP、ALB、TBIL、DBIL與性別無相關(guān)性(P0.05)。長(zhǎng)春市5家實(shí)驗(yàn)室健康兒童的肝功項(xiàng)目測(cè)定值與驗(yàn)證的參考區(qū)間比較,落在參考限以外的測(cè)定值個(gè)數(shù)均不超過驗(yàn)證例數(shù)的10%。本研究建立的2~14歲兒童肝功項(xiàng)目參考區(qū)間水平與行業(yè)標(biāo)準(zhǔn)制定的中國成年人群參考區(qū)間水平不同,2~14歲兒童血清ALT、GGT、TP參考上限明顯低于成人,血清總膽紅素的參考下限及參考上限均低于成人,血清ALP參考下限及參考上限均高于成人,2~6歲兒童AST參考下限及參考上限水平均高于成人,6~14歲降至與成人接近。本研究建立的長(zhǎng)春市2~14歲兒童肝功項(xiàng)目參考區(qū)間在年齡、性別差異上的分段與國內(nèi)外地區(qū)也不盡相同。結(jié)論:1.長(zhǎng)春市2~14歲漢族健康兒童血清肝功項(xiàng)目均有年齡及性別差異,且年齡的差異較顯著,應(yīng)建立不同年齡、性別的兒童血清肝功參考區(qū)間。2.長(zhǎng)春市2~14歲漢族健康兒童血清肝功項(xiàng)目的參考區(qū)間與成人存在差異,為防止臨床判斷失誤,應(yīng)建立兒童血清肝功參考區(qū)間。3.我們建立的長(zhǎng)春市2~14歲漢族健康兒童肝功項(xiàng)目參考區(qū)間可適用于長(zhǎng)春市大多數(shù)實(shí)驗(yàn)室。
[Abstract]:Objective: the reference interval is the basic criterion and basis, explain the test results whose accuracy directly affects the applicability of disease diagnosis efficiency. Liver function tests is the reference interval of liver disease diagnosis and health assessment based on the most basic. Children are different from adults as reference population growth in age, difference of nutrition such factors on the reference interval and adults are not the same, so it is necessary to establish the reference range of children liver projects. The purpose of this study was to establish and validate the commonly used clinical liver function in healthy children of Han Changchun city project reference interval. Methods: the reference range of guide International Federation of clinical chemistry and laboratory medicine and clinical laboratory institute of standardization to develop, in a hospital medical center Changchun city and a maternal and Child Health Hospital of 2~14 years old healthy individual as the research object, through the questionnaire The investigation and physical examination of specimen collection and testing according to the screening criteria for the selection of individual reference, using alanine Hitachi 7600-210 automatic biochemical analyzer to detect the Han healthy children transferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transpeptidase acyl (GGT), alkaline phosphatase (ALP), total protein (TP), albumin (ALB), total bilirubin (TBIL), direct bilirubin (DBIL), reagent and standard are used in Shanghai KELONG bio engineering Limited by Share Ltd products. The data obtained using the EXCEL language, R 3, SPSS 21 statistical software for statistical description and analysis. Check and remove outliers then, to determine whether the data obey the normal distribution, the middle of the 95% interval as the reference interval, the non parametric method to calculate the actual reference sample reference value of the 250 percentile and the 9 thousand and 750 percentile, and calculate the 90% percentile The letter range. By using the Z test to determine gender, age group between groups have no statistically significant differences and gender, age stratified reference interval. Respectively to verify the obtained pediatric reference intervals in different regions of the city Changchun clinical laboratories of 5 hospitals, 14 year old children drawing 2~ serum liver function changes with age the trends of serum liver function and age, gender correlation analysis, the investigation of the reference interval with the national industry standard and different areas in the reference range of results were compared. Results: the study object of study meet the test standard were 1394, all were Han nationality, including 649 men and 745 women. The proportion of men and women 1:1.15. based on the common clinical liver projects 2~14 healthy children of Han Changchun, reference interval, results showed that the liver has age differences in common, all liver projects require 2 The age group above. Enzymes (ALT, AST, GGT project, ALP) have gender differences. No gender differences in serum enzyme level in the low age, high age sex differences begin to appear. But the serum proteins (TP, ALB), bilirubin (TBIL, DBIL) levels showed no gender differences in the age.2~14 years old children in different age with liver projects show different trends of children aged.2~14 years in TP, TBIL and DBIL levels gradually increased with the increase of age, while the level of AST increased with age significantly decreased; ALT, GGT, ALP level changes with age is more complex, 11~14 boy ALT, GGT levels were significantly higher, 13~14 year old girl the level of ALP was significantly decreased.ALT, AST, GGT, ALP, TP, ALB, TBIL, DBIL were significantly correlated with age (P0.05), AST, GGT were significantly correlated with gender, TP, ALB, TBIL, DBIL have no correlation with gender (P0.05). 5 healthy children, liver function Changchun laboratories test items Setting and verification of the reference interval between the reference interval level China adults make a number of not more than the number of cases verified 10%. established in the study of children aged 2~14 liver project reference interval level and industry standard fall determination in reference limit values outside the blood of children aged 2~14, ALT, GGT, TP reference limit serum total bilirubin was significantly lower than that of adults, the lower limit and upper limit reference reference were lower than that of adults, the serum levels of ALP were higher than the upper limit and lower limit reference reference 2~6 AST adults, children reference and reference levels are higher than the upper limit of adults, aged 6~14 years and to get close to people. This study established Changchun 2~14 years old children in liver project reference interval age, gender differences on the segment with the domestic and foreign regions are not the same. Conclusion: 1. Changchun 2~14 years old Han healthy children serum liver function items were age and gender differences, and the age difference was significant That should be established in different age, gender of children and adults the reference range of serum liver function reference interval.2. 2~14 years old Han Changchun healthy children serum liver function project differences, in order to prevent clinical judgment, should establish the children's serum liver function reference interval.3. we established Han 2~14 years old healthy children in Changchun City project reference interval can be applied to liver function Changchun most of the laboratory.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R446.1;R72

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