VWF、AT-Ⅲ、凝血因子对慢加急性肝衰竭的临床预测价值  

Clinical prediction value of VWF,AT-Ⅲ and coagulation factor in acute-on-chronic liver failure

作　　者：胡绍山 杨婧[1] 吕佳珺 李苹菊 刘清清 马红琳 金秋 王莎 董程萱 HU Shaoshan;YANG Jing;LYU Jiajun;LI Pingju;LIU Qingqing;MA Honglin;JIN Qiu;WANG Sha;DONG Chengxuan(Department of Gastroenterology,the Second Affiliated Hospital of Kunming Medical University,Kunming 650000,China)

机构地区：[1]昆明医科大学第二附属医院消化内科,云南昆明650000

出　　处：《胃肠病学和肝病学杂志》2024年第11期1501-1506,1513,共7页Chinese Journal of Gastroenterology and Hepatology

基　　金：昆明医科大学2023年硕士研究生创新基金项目(2023S313)。

摘　　要：目的探讨VWF、AT-Ⅲ、凝血因子对慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)患者的临床预测价值。方法回顾性分析2021年9月至2023年5月昆明医科大学第二附属医院消化内科收治的111例肝硬化患者的临床资料,并计算Child-Pugh评分、MELD评分、MELD-NA评分。分析影响ACLF的相关因素,并评估VWF、AT-Ⅲ、凝血因子对ACLF的预测价值。结果与低MELD组相比,高MELD组IL-6、PCT、CRP、VWF水平升高,差异有统计学意义(P<0.05),而凝血因子Ⅷ水平升高差异无统计学意义(Z=0.169,P=0.866);凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅸ、Ⅹ、Ⅺ、Ⅻ和AT-Ⅲ水平降低,差异有统计学意义(P<0.05)。患者的IL-6、PCT、CRP、VWF、AT-Ⅲ和凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅸ、Ⅹ、Ⅺ、Ⅻ水平在不同Child-Pugh分级中的差异有统计学意义(P<0.05)。单变量分析中,PCT、CRP、VWF、AT-Ⅲ和凝血因子Ⅱ、Ⅶ、Ⅸ、Ⅹ、Ⅺ、Ⅻ与ACLF发生相关(P<0.05)。多因素分析显示,VWF、AT-Ⅲ为ACLF是否发生的独立危险因素(P均<0.05)。AT-Ⅲ、VWF诊断效能ROC曲线分析,AT-Ⅲ的AUC值为0.873(P<0.001),敏感度为94.1%,特异度为73.1%;VWF的AUC值为0.699(P=0.002),敏感度为65.4%,特异度为79.6%。结论肝硬化患者的IL-6、PCT、CRP、VWF、AT-Ⅲ和凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅸ、Ⅹ、Ⅺ、Ⅻ水平在不同Child-Pugh分级中存在差异;肝硬化患者MELD评分增大,IL-6、PCT、CRP、VWF水平升高,凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅸ、Ⅹ、Ⅺ、Ⅻ和AT-Ⅲ水平降低;AT-Ⅲ、VWF是ACLF的独立危险因素,可一定程度预测ACLF的发生,为ACLF的诊断提供依据。Objective To investigate the clinical prediction value of VWF,AT-Ⅲ and coagulation factor in patients with acute-on-chronic liver failure(ACLF).Methods A retrospective analysis was per-formed for the data of 111 patients with cirrhosis admitted to the Department of Gastroenterology,the Second Affiliated Hospital of Kunming Medical University from Sep.2021 to May 2023.Child-Pugh score,MELD score and MELD-NA score were calculated based on the collected data.The related factors affecting ACLF were analyzed,and the predictive value of VWF,AT-Ⅲ and coagulation factor for ACLF was evaluated.Results Compared with low MELD group,it has a higher levels of IL-6,PCT,CRP,VWF and a lower levels of coagulation factor Ⅱ,Ⅴ,Ⅶ,Ⅸ,Ⅹ,Ⅺ,Ⅻ and AT-Ⅲ in high MELD group,while the increase of factor Ⅷ level was not statistically significant(Z=0.169,P=0.866).The levels of IL-6,PCT,CRP,VWF,AT-Ⅲ and coagulation factorⅡ,Ⅶ,Ⅸ,Ⅹ,Ⅺ,Ⅻin patients showed statistically significant differences across various Child-Pugh classes(P<0.05).In univariate analysis,PCT,CRP,VWF and coagulation factor Ⅱ,Ⅴ,Ⅶ,Ⅸ,Ⅹ,Ⅺ,Ⅻ were correlated with ACLF(P<0.05).Multifactor analysis showed that VWF and AT-Ⅲ were independent risk factors for the occurrence of ACLF(P<0.05).According to the ROC curve analysis of diagnostic efficacy of AT-Ⅲ and VWF,the AUC value of AT-Ⅲ was 0.873(P<0.001),the sensitivity was 94.1%,and the specificity was 73.1%.The AUC of VWF was 0.699(P=0.002),the sensitivity was 65.4%,and the specificity was 79.6%.Conclusion The levels of IL-6,PCT,CRP,VWF,AT-Ⅲ and coagulation factor Ⅱ,Ⅴ,Ⅶ,Ⅸ,Ⅹ,Ⅺ,Ⅻ in liver cirrhosis patients are different across various Child-Pugh classes.An increased MELD score in liver cirrhosis patients is associated with higher levels of IL-6,PCT,CRP and VWF,and lower levels of coagulation factor Ⅱ,Ⅴ,Ⅶ,Ⅸ,Ⅹ,Ⅺ,Ⅻ and AT-Ⅲ.AT-Ⅲ and VWF are independent risk factors for ACLF and can predict the occurrence of ACLF to a certain extent,providing a basis for the d

关 键 词：慢加急性肝衰竭 VWF AT-Ⅲ 凝血因子 预测价值 

分 类 号：R575[医药卫生—消化系统]