血清维生素B12水平预测肝硬化食管胃静脉曲张患者再出血的诊断价值

The dignostic value of serum vitamin B12 in predicting rebleeding in patients with liver cirrhosis of esophagogastric varices

目的探讨血清维生素B12作为无创指标预测肝硬化伴食管胃静脉曲张患者远期再出血预后的价值。方法纳入2016年12月1日至2017年12月31日因肝硬化食管胃静脉曲张出血至复旦大学附属中山医院接受内镜治疗预防再出血并行血清维生素B12、叶酸检测的患者.对患者内镜之后3年再出血进行ROC曲线、Kaplan-Meier生存分析、单因素及多因素Cox回归分析,探讨不同维生素B12水平预测3年静脉曲张再出血的价值。结果共纳入115例患者,ROC曲线分析提示血清维生素B12预测3年再出血的最佳截断值为567.25 pg/ml,根据截断值将患者分为高维生素B12水平组(n=49)和低维生素B12水平组(n=66)。与维生素B12低水平组比较,维生素B12高水平组患者白蛋白水平偏低,男性比例更少(63.3%vs 80.3%),3年再出血率更高(P<0.05):Cox分析提示维生素B12及血小板是静脉曲张出血患者3年再出血的独立预后因素.结论外周血维生素B12升高预示肝硬化食管胃静脉曲张患者更高的远期再出血风险。

Objective The aim of this study was to investigate the prognostic value of vitamin B12 as the non-invasive biomarker to predict long-term rebleeding rate in cirrhotic patients with esophagogastric varices.Methods From Dec 1,2016 to Dec 31,2017,cirrhotic patients with esophagogastric varices who had been admitted to Zhongshan Hospital affiliated to Fudan University were enrolled.All these patients received endoscopic treatment to prevent variceal rehleeding.The serum vitamin B12 and folic acid levels were measured in all of them.The receiver operating characteristic(ROC)analysis,Kaplan-Meier analysis,univariate and multivariate cox regression analysis were conducted to explore the value of vitamin B12 in predicting 3-year variceal rebleeding in cirrhotic patients with esopfiagogastric varices after endoscopic treatment.Results 115 patients were included.The ROC curve analysis indicated that the optimal cutoff value of vitamin B12 for 3-year variceal rebleeding was 567.25 pg/ml.According to the cut-off value,the patients were divided into high-level vitamin B12 group(n=49)and low-level vitamin B12 group(n=66).Compared with the low vitamin B12 group,the high vitamin B12 group had lower albumin level,less male(63.3% vs 80.3%),and higher 3-year rebleeding rate(P<0.05).Cox analysis showed that vitamin B12 and platelet were independent prognostic factors for 3-year rebleeding in patients with variceal bleeding.Conclusions Elevated peripheral blood vitamin B12 predicts a higher risk of long-term rebleeding in patients with liver cirrhosis and esophagogastric varices.