血管性血友病因子及VITRO评分评估HBV感染患者疾病进展的临床价值  

The clinical value of von Willebrand factor and VITRO score in evaluating disease progression in patients with HBV infection

作　　者：关雅兰 张大志[1] 杨轶轩[1] 万仁均 唐璐琪 曾维琼[2] 康娟[1] Guan Yalan;Zhang Dazhi;Yang Yixuan;Wan Renjun;Tang Luqi;Zeng Weiqiong;Kang Juan(Key Laboratory of Molecular Biology for Infectious Diseases(Ministry of Education),Department of Infectious Diseases,the Second Affiliated Hospital,Chongqing Medical University,Chongqing 400010,China;Institute for viral Hepatitis,Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第二医院感染科重庆医科大学感染性疾病分子生物学教育部重点实验室,重庆400010 [2]重庆医科大学病毒性肝炎研究所,重庆400010

出　　处：《中华肝脏病杂志》2022年第3期309-315,共7页Chinese Journal of Hepatology

基　　金：重庆市自然科学基金面上项目(cstc2020jcyj-msxmX0015);中国肝炎防治基金会天晴肝病研究基金(TQGB20190110);重庆医科大学未来医学青年创新团队(W0027)。

摘　　要：目的:探讨血管性血友病因子(vWF)及VITRO评分(vWF/血小板计数数值的比值)评估乙型肝炎病毒(HBV)感染患者疾病进展的临床价值。方法:随机收集重庆医科大学附属第二医院2018年12月1日—2021年1月5日308例HBV感染患者(包括154例慢性乙型肝炎、66例乙型肝炎肝硬化代偿期、88例乙型肝炎肝硬化失代偿期)的相关临床数据,vWF数值均采用统一的光学法测定,所有数据均使用统一标准纳入,并分析血浆vWF水平及VITRO评分在慢性乙型肝炎、乙型肝炎肝硬化代偿期及失代偿期各组中的差别及意义。结果:慢性乙型肝炎组的血浆vWF水平及VITRO评分数值分别为(139.47%±76.44%、0.86±0.8),乙型肝炎肝硬化代偿期组分别为(164.95%±67.12%和1.44±1.14)、乙型肝炎肝硬化失代偿期组分别为(317.48%±103.32%和6.81±4.98);血浆vWF水平及VITRO评分随HBV感染患者疾病进展而增高,差异有统计学意义(F值分别为133.669、137.598,P值均<0.001)。乙型肝炎肝硬化患者中血浆vWF水平及VITRO评分数值在Child-Pugh A级组分别为(185.65%±85.07%和2.3±2.37)、B级组为(304.74%±105.81%和6.37±5.19)、C级组为(369.48%±73.23%和8.28±5.38);乙型肝炎肝硬化患者中血浆vWF水平及VITRO评分随着Child-Pugh分级等级的增高而增高,差异有统计学意义(F值分别为60.236、32.854,P值均<0.001)。血浆vWF水平及VITRO评分诊断乙型肝炎肝硬化失代偿期的曲线下面积(AUC)分别为0.897[95%可信区间(CI):0.855~0.940,P<0.01]、0.949[95%CI:0.916~0.982,P<0.01]。vWF水平及VITRO评分分别取界值为238.5%和1.65时,诊断乙型肝炎肝硬化失代偿期的敏感度分别为79.5%和94.3%,特异度为92.3%和87.7%,阳性预测值为80.5%和94.3%,阴性预测值为91.9%和97.5%,诊断准确率为88.6%和89.3%。乙型肝炎肝硬化失代偿期患者中,有消化道出血组vWF水平为367.24%±68.29%显著高于无消化道出血组的286.15%±109.69%,差异有统计学意义(P<0.001);有消化道出血Objective To explore the clinical value of von Willebrand Factor(vWF)and VITRO score(vWF:Ag/platelet count)in assessing disease progression in patients with HBV infection.Methods Randomly collect relevant clinical data of 308 patients with HBV infection(including 154 cases of chronic hepatitis B,66 cases of hepatitis B cirrhosis in compensatory period,88 cases of hepatitis B cirrhosis in decompensated period)from December 1,2018 to January 5,2021 in the Second Affiliated Hospital of Chongqing Medical University.The vWF values are measured by a uniform optical method,and all data are included using a uniform standard.Analyze the difference and significance of plasma vWF level and VITRO score in chronic hepatitis B,hepatitis B cirrhosis in the compensatory phase and decompensated phase.Results The plasma vWF level and VITRO score of the chronic hepatitis B group were(139.47±76.44)and(0.86±0.8),respectively,and the hepatitis B cirrhosis compensated group was(164.95±67.12 and 1.44±1.14),respectively.Hepatitis cirrhosis decompensated group were(317.48±103.32 and 6.81±4.98),respectively;plasma vWF level and VITRO score increased with the progression of HBV infection,and the difference was statistically significant(F=133.669,P=0.000和F=137.598,P=0.000).The plasma vWF level and VITRO score in patients with hepatitis B cirrhosis were(185.65±85.07 and 2.3±2.37)in the Child-Pugh A group,(304.74±105.81 and 6.37±5.19)in the B grade group,and(369.48±73.23和8.28±5.38)in the C grade group;plasma vWF level and VITRO score in patients with hepatitis B cirrhosis increased with the increase of Child-Pugh grade,and the difference was statistically significant(F=60.236,P=0.000和F=32.854,P=0.000).The area under the curve(AUC)of plasma vWF level and VITRO score for diagnosing the decompensated stage of hepatitis B cirrhosis were 0.897[95%confidence interval(CI):0.855-0.940,P<0.01],0.949[95%CI:0.916-0.982,P<0.01).When the vWF level and VITRO score were taken as cut-off values of 238.5%and 1.65,respectively,the sensitivity

关 键 词：慢性乙型肝炎 肝硬化 血管性血友病因子 VITRO评分 消化道出血 

分 类 号：R512.62[医药卫生—内科学]