本文選題：原發(fā)性醛固酮增多癥　切入點(diǎn)：腎上腺瘤手術(shù)　出處：《福建醫(yī)科大學(xué)》2015年碩士論文

【摘要】：【目的】驗(yàn)證Aldosteronoma Resolution Score(簡(jiǎn)稱ARS評(píng)分表)在預(yù)測(cè)接受腎上腺瘤(ALD-producing adenoma,APA)患者術(shù)后高血壓的治愈情況的準(zhǔn)確性,評(píng)價(jià)其臨床應(yīng)用價(jià)值;并通過(guò)引入新的變量進(jìn)一步完善ARS評(píng)分表,以期建立一種可以更準(zhǔn)確預(yù)測(cè)原醛癥患者腎上腺瘤術(shù)后高血壓預(yù)后情況的評(píng)分表�！痉椒ā渴占�2002年1月-2014年12月間,來(lái)自兩家醫(yī)院共115例APA引起原發(fā)性醛固酮增多癥患者的臨床資料,包括:一般信息、病史信息、實(shí)驗(yàn)室和檢查資料,以及高血壓的預(yù)后情況和降壓藥的使用種類等,。利用ARS評(píng)分表對(duì)患者進(jìn)行評(píng)估分級(jí)。,繪制受試者工作曲線(ROC曲線),評(píng)價(jià)ARS評(píng)分表的應(yīng)用價(jià)值。利用單因素分析,篩選影響APA術(shù)后高血壓預(yù)后的其它影響因素,logistic回歸分析驗(yàn)證其相關(guān)性,在原ARS評(píng)分表的基礎(chǔ)上,將有統(tǒng)計(jì)學(xué)意義的新變量--高血壓家族史、術(shù)后第一天血壓引入,按照各變量標(biāo)準(zhǔn)化系數(shù)的大小,將變量賦值并組成改良ARS評(píng)分表。繪制改良ARS評(píng)分表的ROC曲線,評(píng)價(jià)其對(duì)APA患者術(shù)后高血壓預(yù)后的預(yù)測(cè)準(zhǔn)確性。進(jìn)一步對(duì)比兩種評(píng)分表的ROC曲線,比較兩種評(píng)分表的準(zhǔn)確性和評(píng)估其應(yīng)用價(jià)值。【結(jié)果】原版ARS評(píng)分表ROC曲線下的面積為0.903,改良ARS評(píng)分表曲線下面積為0.945,經(jīng)檢驗(yàn)均有統(tǒng)計(jì)學(xué)意義(P0.05),說(shuō)明兩種ARS評(píng)分表對(duì)于原醛腎上腺瘤術(shù)后高血壓的預(yù)后評(píng)估均存在應(yīng)用價(jià)值。原版ARS評(píng)分表臨界點(diǎn)為1和3,以1分和3分作為臨界點(diǎn),根據(jù)ROC曲線將改良ARS評(píng)分表分為如下3個(gè)等級(jí):低等(0—1分);中等(2—3分);高等(4—5分),所對(duì)應(yīng)的高血壓治愈率分別是27.3%、77.8%和100%。根據(jù)改良ROC曲線確定臨界點(diǎn)為3和8,以3分和8分作為臨界點(diǎn)將改良ARS評(píng)分表分為如下3個(gè)等級(jí):低等(0-3分)、中等(4-7分)和高等(8-11分),所對(duì)應(yīng)的高血壓治愈率分別是0、60.5%和98.5%。兩種ARS評(píng)分表均表明,評(píng)分等級(jí)越高,高血壓預(yù)后的預(yù)測(cè)準(zhǔn)確性越高。比較兩種評(píng)分表的高血壓治愈率,改良ARS評(píng)分表高分段的治愈率更高,而低分段的治愈率更低,P0.05,有統(tǒng)計(jì)學(xué)意義(P0.05,),說(shuō)明改良ARS評(píng)分表對(duì)原醛腎上腺瘤術(shù)后高血壓預(yù)后的評(píng)估更好。比較ROC曲線,改良ARS評(píng)分表的ROC曲線更靠近左上角,曲線下面積(AUC)更大,因此改良ARS評(píng)分表比原版ARS評(píng)分表準(zhǔn)確性和應(yīng)用價(jià)值更好�！窘Y(jié)論】原版ARS評(píng)分表對(duì)于APA患者術(shù)后高血壓的預(yù)后評(píng)估有應(yīng)用價(jià)值。六個(gè)變量--性別、身高體重指數(shù)BMI、術(shù)前高血壓病程、術(shù)前抗高血壓藥物種類、高血壓家族史和術(shù)后第一天血壓均與APA術(shù)后高血壓預(yù)后相關(guān),利用上述變量組成的改良ARS評(píng)分表也存在應(yīng)用價(jià)值。比較兩種評(píng)分表的高血壓治愈的預(yù)測(cè)準(zhǔn)確性和ROC曲線,均說(shuō)明在本研究中改良ARS評(píng)分表比原版ARS評(píng)分表準(zhǔn)確性和應(yīng)用價(jià)值更高。
[Abstract]:[objective] to verify the accuracy of Aldosteronoma Resolution score (ARS scale) in predicting the cure of hypertension after adrenal tumor ALD-producing adenoma, and to evaluate its clinical application value, and to improve the ARS score table by introducing new variables. [methods] to establish a scoring table that can more accurately predict the prognosis of hypertension after adrenal neoplasms in patients with proaldehydes. [methods] from January 2002 to December 2014, Clinical data of 115 patients with primary aldosteronism caused by APA from two hospitals, including general information, medical history information, laboratory and laboratory data, The prognosis of hypertension and the use of antihypertensive drugs were evaluated by ARS scale. The operating curve of subjects was drawn to evaluate the application value of ARS score table, and the single factor analysis was used. Other factors influencing the prognosis of hypertension after APA were screened. Logistic regression analysis was used to verify the correlation. On the basis of the original ARS score table, the family history of hypertension, a statistically significant new variable, was introduced into the blood pressure on the first day after operation. According to the size of the standardized coefficient of each variable, the variables are assigned and the modified ARS scoring table is formed. The ROC curve of the modified ARS scoring table is drawn. To evaluate its accuracy in predicting the prognosis of hypertension after APA. Further compare the ROC curves of the two scoring tables. [results] the area under the ROC curve of the original ARS scoring table is 0.903, and the area under the modified ARS scoring table curve is 0.945. The critical points of the original ARS scale were 1 and 3, with 1 and 3 as the critical points. According to the ROC curve, the modified ARS score scale is divided into the following three grades: low grade 0-1 score, middle grade 2-3 minutes, high grade 4-5 minutes, the corresponding cure rate of hypertension is 27.3% and 100th respectively. According to the modified ROC curve, the critical points are 3 and 8, and the critical points are 3 and 8 respectively, and the corresponding cure rates of hypertension are 27.3% and 100th, respectively. According to the modified ROC curve, the critical points are determined to be 3 and 8. The improved ARS score scale was divided into three grades as follows: low grade 0-3 scores, medium scale 4-7 scores) and higher scores of 8-11 points. The corresponding cure rates of hypertension were 0% and 98.5%, respectively. The two kinds of ARS scores showed that. The higher the score, the higher the accuracy of predicting the prognosis of hypertension. The cure rate of low segment was lower than that of P0.05, which showed that the modified ARS scale was better in evaluating the prognosis of hypertension after adrenal neoplasms. Compared with the ROC curve, the ROC curve of the modified ARS scale was closer to the upper left corner. The area under the curve is larger, so the improved ARS scoring table has better accuracy and application value than the original ARS scoring table. [conclusion] the original ARS scoring table is valuable in evaluating the prognosis of postoperative hypertension in APA patients. Height and body mass index (BMI), duration of hypertension before operation, kinds of antihypertensive drugs before operation, family history of hypertension and blood pressure on the first day after APA were all related to the prognosis of hypertension after APA. The modified ARS scale, which is composed of the above variables, also has application value. The accuracy of predicting hypertension cure and the ROC curve of the two scoring tables are compared. All of these indicate that the improved ARS scoring table is more accurate and more valuable than the original ARS scoring table in this study.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R736.6;R544.1

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