肝硬化合并门静脉血栓患者外周血血管内皮生长因子的检测及意义

Measurement and clinical significance of peripheral blood vascular endothelial growth factor in patients with liver cirrhosis and portal vein thrombosis

目的了解血管内皮生长因子(VEGF)在肝硬化合并门静脉血栓(PVT)患者外周血中水平,阐明其水平检测作为肝硬化合并PVT诊断的临床意义。方法选取2017年1月-2019年12月在苏州大学附属第一医院门诊随访或者住院的肝硬化合并PVT患者60例(PVT组),同期肝硬化合并门静脉高压但无血栓者161例(LC组)。收集入组患者的临床数据,包括性别、年龄、WBC、PLT、TBil、ALT、Alb、PT、INR、AT-Ⅲ水平。双抗体夹心原理酶联免疫吸附法检测血清VEGF水平。正态分布的计量资料2组间比较采用t检验;非正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ^2检验。相关性分析采用Pearson相关检验。二分类logistic回归分析肝硬化患者发生PVT的危险因素。结果PVT组与LC组患者基线指标比较,血清VEGF水平差异有统计学意义(Z=-6.682,P<0.05)。不论是Child-Pugh A级还是B+C级,2组患者血清VEGF水平差异均有统计学意义(Z值分别3.749、5.469,P值均<0.05)。逐步logistic回归分析显示只有血清VEGF水平是肝硬化合并PVT的独立危险因素(OR=1.004,95%CI:1.003~1.006,P<0.001)。结论肝硬化合并PVT患者外周血VEGF有着更高的表达水平,对临床诊断有指导作用。

Objective To investigate the level of vascular endothelial growth factor(VEGF)in the peripheral blood of patients with liver cirrhosis and portal vein thrombosis(PVT)and its clinical significance in the diagnosis of liver cirrhosis with PVT.Methods A total of 60 patients with liver cirrhosis and PVT who were followed up or hospitalized in the outpatient service of The First Affiliated Hospital of Soochow University from January 2017 to December 2019 were enrolled as PVT group,and 161 patients with liver cirrhosis and portal hypertension who had no thrombi were enrolled as LC group.Related clinical data were collected,including sex,age,white blood cell count,platelet count,total bilirubin,alanine aminotransferase,albumin,prothrombin time,international normalized ratio,and antithrombinⅢ.Double-antibody sandwich ELISA was used to measure the serum level of VEGF.The t-test was used for comparison of normally distributed continuous data between two groups,and 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 two groups.The Pearson correlation test was used for correlation analysis,and a binary logistic regression analysis was used to investigate the risk factors for PVT in patients with liver cirrhosis.Results The comparison of baseline indices showed that there was a significant difference in serum VEGF between the PVT group and the LC group(P<0.05).The comparison of the patients with Child-Pugh class A,B or C disease showed that there was a significant difference in serum VEGF between the two groups(Z=3.749,5.469,all P<0.05).The stepwise logistic regression analysis showed that only serum VEGF(odds ratio=1.004,95%confidence interval:1.003-1.006,P<0.001)was an independent risk factor for liver cirrhosis with PVT.Conclusion Patients with liver cirrhosis and PVT tend to have a high level of VEGF in peripheral blood,which provides guidance for clinical diagnosis.