血管性血友病因子抗原与白蛋白比值和糖萼素指数评分对乙型肝炎肝硬化食管静脉曲张的预测价值  

Value of von Willebrand factor antigen-to-albumin ratio and glycocalicin index in predicting esophageal varices in hepatitis B cirrhosis

作　　者：韩才均 黄媛[2] 粘彬 朴美花[1] HAN Caijun;HUANG Yuan;NIAN Bin;PIAO Meihua(Department of Medical Laboratory,The Affiliated Hospital of Yanbian University,Yanji,Jilin 133000,China;Department of Gastroenterology,The Affiliated Hospital of Yanbian University,Yanji,Jilin 133000,China;Department of Ultrasonography,The Affiliated Hospital of Yanbian University,Yanji,Jilin 133000,China)

机构地区：[1]延边大学附属医院检验科,吉林延吉133000 [2]延边大学附属医院消化内科,吉林延吉133000 [3]延边大学附属医院超声科,吉林延吉133000

出　　处：《临床肝胆病杂志》2022年第12期2750-2754,共5页Journal of Clinical Hepatology

基　　金：延边大学应用基础项目(2020-45)。

摘　　要：目的与血管性血友病因子抗原(vWF-Ag)与血小板比值(VITRO)评分比较,探讨vWF-Ag与白蛋白比值(VAR)和糖萼素指数(GCI)评分在预测食管静脉曲张(EV)发生及分级中的临床价值。方法回顾性分析2020年4月—2021年12月于延边大学附属医院住院的乙型肝炎肝硬化患者146例,以胃镜检查为标准,对EV进行诊断和分级。计算VITRO、VAR和GCI值,分析其与EV相关性。正态分布计量资料两组间比较采用t检验,多组间比较采用单因素方差分析;非正态性分布计量资料两组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ^(2)检验。采用Logistic回归模型分析EV的预测因素。使用受试者工作特征曲线(ROC曲线)评估各指标的诊断准确性。结果胃镜检查显示无EV患者54例,轻、中、重度EV患者分别为30、33和29例。EV患者的VAR和GCI评分显著高于无EV患者,差异有统计学意义(t值分别为-5.819、-3.449,P值均<0.001)。线性回归显示VAR和GCI均随EV分级而升高(P值分别为0.002、0.005)。多变量回归分析确定VAR(风险比=1.46,95%CI:1.21~1.75,P<0.001)和GCI(风险比=1.84,95%CI:1.22~2.77,P=0.003)与EV独立相关。VITRO评分诊断EV和重度EV的ROC曲线下面积(AUC)分别为0.718和0.863;临界值分别为2.77和5.37。VAR和GCI诊断EV的AUC分别为0.745和0.710,临界值分别为8.88和1.70;两者诊断重度EV的AUC分别为0.755和0.787,临界值分别为9.81和2.00。VAR联合GCI对EV诊断效能明显优于VITRO(P=0.009),其AUC为0.808,敏感度为55.43%,特异度为94.44%;而联合模型对重度EV的AUC为0.869,与VITRO比较差异无统计学意义(P=0.421)。结论VAR和GCI评分是预测乙型肝炎肝硬化患者EV和风险分层的潜在非侵入性标志物。Objective To investigate the clinical value of von Willebrand factor antigen-to-albumin ratio(VAR)score and glycocalicin index(GCI)score in predicting the development and classification of esophageal varices in comparison with von Willebrand factor antigen-to-platelet ratio(VITRO)score.Methods A retrospective analysis was performed for 146 patients with hepatitis B cirrhosis who were hospitalized from April 2020 to December 2021,and esophageal varices(EV)was diagnosed and graded with the results of gastroscopy as the standard.VITRO,VAR,and GCI were calculated,and their association with EV was analyzed.The t-test was used for comparison of normally distributed continuous data between two groups,and a one-way analysis of variance was used for comparison between multiple groups;the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups.The chi-square test was used for comparison of categorical data between groups.A logistic regression model analysis was used to identify the predictive factors for EV,and the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic accuracy of each index.Results Gastroscopy showed 54 patients without EV,30 with mild EV,33 with moderate EV,and 29 with severe EV.The patients with EV had significantly higher VAR and GCI scores than those without EV(t=-5.819 and-3.449,both P<0.001).The linear regression analysis showed that VAR and GCI increased with the increase in EV grade(P=0.002 and 0.005).The multivariate logistic regression analysis showed that VAR(odds ratio[OR]=1.46,95%confidence interval[CI]:1.21-1.75,P<0.001)and GCI(OR=1.84,95%CI:1.22-2.77,P=0.003)were independently associated with EV.VITRO score had an area under the ROC curve(AUC)of 0.718 in diagnosing EV and 0.863 in diagnosing severe EV,with the optimal cut-off values of 2.77 and 5.37,respectively.VAR and GCI had an AUC of 0.745 and 0.710,respectively,in diagnosing EV,with the optimal cut-off values of 8.88 and 1.70,respectively;VAR and GCI had an AUC

关 键 词：乙型肝炎 肝硬化 食管和胃静脉曲张 

分 类 号：R575.2[医药卫生—消化系统]