Dokument: Diagnostik der Leberzirrhose mittels transienter Elastographie im Vergleich zu klinischen Zeichen, Laborparametern und Ultraschall
| Titel: | Diagnostik der Leberzirrhose mittels transienter Elastographie im Vergleich zu klinischen Zeichen, Laborparametern und Ultraschall | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=21636 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20120614-093403-7 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Schadewaldt, Janine [Autor] | |||||||
| Dateien: |
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| Beitragende: | Prof. Dr. Erhardt, Andreas [Betreuer/Doktorvater] Prof. Dr. Baldus, Stephan Ernst [Gutachter] Prof. Dr. Blondin, Dirk [Gutachter] | |||||||
| Stichwörter: | Leberzirrhose - transiente Elastographie | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibung: | Die Diagnose der Leberzirrhose ist in der alltäglichen Praxis, in der die Diagnostik auf der klinischen Untersuchung, einfachen Laborparametern und Ultraschall basiert, bisher oft schwierig. Trotz der zunehmenden Verbreitung der transienten Elastographie wurde die Effizienz zur Diagnostik der Leberzirrhose im klinischen Alltag bisher wenig untersucht. Ziel dieser Studie war es daher, den Nutzen der transienten Elastographie (FibroScan®) zur Diagnose der Leberzirrhose im Vergleich zu den überall anwendbaren und somit routinemäßig genutzten diagnostischen Mitteln zu bestimmen. Dafür wurden unter anderem transiente Elastographie, Sonographie, Thrombozytenzahl und Leberhautzeichen bei 182 Patienten mit histologisch gesicherter Leberzirrhose verschiedener Ätiologien durchgeführt. Die Sensitivität der transienten Elastographie für die Diagnose der Leberzirrhose betrug 90.4%, im Vergleich dazu ergaben sich Sensitivitäten von 80.1% für die Sonographie, 58.0% für die Thrombozytenzahl und 45.1% für die Leberhautzeichen (p < 0.0001 für den Vergleich). Die Spezifität für die transiente Elastographie betrug 51.4%, der positive prädiktive Wert 75.2% und der negative prädiktive Wert 76.7%. Die “Area Under the Receiver Operating Characteristic Curve” (AUROC) ergab einen Wert von 0.760 (95% CI: 0.694 – 0.825). Kombinationen aus transienter Elastographie mit Ultraschall, Thrombozytenzahl oder Leberhautzeichen ließen eine Steigerung der Sensitivität auf maximal 96.1% und des AUROC-Wertes auf maximal 0.825 (95% CI: 0.768 – 0.882) zu. Die Lebersteifigkeitsmessungen mittels transienter Elastographie korrelierten mit Laborparametern, die den Zirrhosefortschritt anzeigen, wie Albumin (r = -0.43) und Bilirubin (r = 0.34; p jeweils < 0.001). Mit Hilfe der transienten Elastographie ließ sich die Sensitivität zur Diagnose der Leberzirrhose im Vergleich zur Sonographie auch bei Patienten mit normalen Thrombozytenzahlen oder einem Child Pugh A-Score um 14.1% (p < 0.04) und 15.3% (p < 0.02) steigern. Insgesamt ist die transiente Elastographie gegenüber den anderen routinemäßig verfügbaren Diagnoseverfahren bezüglich der Sensitivität überlegen. Sie erlaubt bei Patienten mit chronischen Lebererkrankungen eine Steigerung der Diagnosegenauigkeit um rund 10% und ermöglicht somit die Entdeckung von Zirrhosen, die bei den konventionellen klinischen Untersuchungsmethoden unentdeckt geblieben wären. Am Größten ist der zusätzliche Nutzen der transienten Elastographie bei Patienten mit früher Leberzirrhose. Durch die Kombination mit dem Ulatraschall ist ein weiterer Gewinn an Sensitivität zu erzielen. | |||||||
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| Lizenz: |  Urheberrechtsschutz | |||||||
| Bezug: | 2006-2011 | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 14.06.2012 | |||||||
| Dateien geändert am: | 14.06.2012 | |||||||
| Promotionsantrag am: | 17.08.2011 | |||||||
| Datum der Promotion: | 31.05.2012 |
