血管性血友病因子水平联合MELD评分体系对肝硬化短期预后的预测价值  

The addition of von Willebrand factor to MELD scoring system improves prediction of short-term prognosis in liver cirrhosis

作　　者：庄焱[1] 林兰意 ZHUANG Yan;LIN lan-yi(Department of Infectious Diseases,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 100025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院感染科,100025

出　　处：《肝脏》2023年第7期759-763,共5页Chinese Hepatology

基　　金：国家自然科学基金面上项目(NSFC81970544)。

摘　　要：目的探讨血浆血管性血友病因子(vWF)水平与肝硬化严重程度的关系及其联合终末期肝病模型(MELD)评分体系对肝硬化患者短期预后的预测价值。方法随机收集2017年9月至2022年3月于上海交通大学医学院附属瑞金医院感染科住院的肝硬化患者共234例。检测所有患者的血浆vWF:Ag水平,收集相关临床数据。分析血浆vWF:Ag水平与MELD和MELD-Na评分的相关性,评估血浆vWF:Ag水平对肝硬化患者未来1个月和3个月发生死亡/肝移植的预测作用,构建vWF:Ag联合MELD改良评分,以期提高诊断价值。结果血浆vWF:Ag水平与MELD和MELD-Na评分均呈正相关,随两者的升高而升高(r=0.576和r=0.579,P均<0.01)。分别有16.7%(29/174)和24.8%(38/153)的患者在其后1个月和3个月时发生死亡/肝移植。各时间点死亡/肝移植组患者的血浆vWF:Ag水平均显著高于非死亡/肝移植组(1个月非死亡/肝移植组vs死亡/肝移植组:(224.4±42.7)%vs(260.7±34.5)%,P<0.01;3个月非死亡/肝移植组vs死亡/肝移植组:(219.0±40.3)%vs(262.5±34.2)%,P<0.01)。多因素分析结果显示,血浆vWF:Ag水平是3个月死亡/肝移植的独立预测因素(OR=1.026,95%CI:1.006~1.046,P<0.01),其诊断的ROC曲线下面积(AUC)为0.795,略低于MELD评分的0.835和MELD-Na评分的0.851。构建vWF:Ag联合MELD-Na改良评分可将诊断的AUC提高至0.881。结论肝硬化患者的血浆vWF:Ag水平随肝病的严重程度而升高。血浆vWF:Ag水平是3个月死亡/肝移植的独立预测因素,vWF:Ag联合MELD-Na改良评分可进一步提高其诊断价值。Objective To determine the relationship of plasma von Willebrand factor(vWF)level and the severity of liver cirrhosis and its predictive value when combined with the MELD scoring system in short-term prognosis.Methods A total of 234 cirrhotic patients who were hospitalized in Department of Infectious Diseases,Ruijin Hospital from September 2017 to March 2022 were initially enrolled.Plasma vWF:Ag levels were measured and clinical data were recorded.The correlations between plasma vWF:Ag level and MELD/MELD-Na scores were analyzed.Its predictive effect on 1-month and 3-month prognosis were evaluated.Results Plasma vWF:Ag levels were positively correlated with MELD and MELD-Na scores(r=0.576 and r=0.579,both P<0.01).Death/liver transplantation occurred in 16.7%(29/174)and 24.8%(38/153)of patients at 1 and 3 months,respectively.Plasma vWF:Ag levels in higher mortality risk groups were both significantly higher than those in lower mortality risk groups(1 month,non-death/liver transplantation vs death/liver transplantation,224.4±42.7%vs 260.7±34.5%,P<0.01;3 months,non-death/liver transplantation vs death/liver transplantation,219.0±40.3%vs 262.5±34.2%,P<0.01).Multivariate analysis revealed that plasma vWF:Ag level was independently associated with 3-month death/liver transplantation(OR=1.026,95%CI:1.006~1.046,P<0.01).Prediction of 3-month mortality risk was assessed by receiver operating characteristic curve(ROC-AUC).The diagnostic performance of MELD-Na score was slightly higher than those of MELD score and plasma vWF:Ag level in terms of 3-months outcome,which can be improved by of plasma vWF:Ag level incorporated into MELD-Na score as MELD-Na-vWF score(AUC:vWF:Ag,0.795;MELD,0.835;MELD-Na,0.851;MELD-Na-vWF,0.881).Conclusion Plasma vWF:Ag level increases with the severity of liver cirrhosis.vWF:Ag was an independent predictor of death/liver transplantation at 3 months.The addition of vWF-Ag to MELD-Na score improves prediction value.

关 键 词：血管性血友病因子 肝硬化 终末期肝病模型 预后 

分 类 号：R575.2[医药卫生—消化系统]