肝硬化食管胃底静脉曲张破裂出血患者血清中胰岛素样生长因子结合蛋白-3的水平变化及临床意义

Changes and clinical significance of serum insulin-like growth factor binding protein-3 in patients with hemorrhage from esophageal and gastric fundus varicose veins of liver cirrhosis

目的探究胰岛素样生长因子结合蛋白-3(IGFBP-3)在肝硬化食管胃底静脉曲张破裂出血患者血清中的表达水平及临床意义。方法选择2017年2月至2018年6月在苏州市中西医结合医院就诊的242例肝硬化食管胃底静脉曲张破裂出血患者作为研究对象。根据治疗后是否发生再出血将患者分为未出血组(n=160)和再出血组(n=82)。采用ELISA法检测患者血清IGFBP-3的表达水平,并分析其与患者发生再出血的关系。结果再出血组血清IGFBP-3的表达水平高于未出血组,两组差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,Child-Pugh分级为C级、门静脉内径、白细胞计数和IGFBP-3是肝硬化食管胃底静脉曲张破裂出血后发生再出血的独立危险因素(P均<0.05),血钠是肝硬化食管胃底静脉曲张破裂出血后发生再出血的独立保护因素(P<0.05)。IGFBP-3预测肝硬化食管胃底静脉曲张破裂出血后发生再出血的ROC曲线下面积(AUC)、敏感度和特异度分别为0.894、97.56%和70.00%。构建预测肝硬化食管胃底静脉曲张破裂出血后发生再出血的logistic回归模型(由Child-Pugh分级、门静脉内径、白细胞计数、血钠和IGFBP-3组成)列线图,其拟合曲线与理想曲线的重合度较高,一致性指数(C指数)为0.962。结论IGFBP-3在肝硬化食管胃底静脉曲张破裂出血患者血清中的表达水平越高,提示患者发生再出血的风险越高。由Child-Pugh分级、门静脉内径、白细胞计数、血钠和IGFBP-3构建的logistic回归模型列线图可以有效评估肝硬化食管胃底静脉曲张破裂出血后发生再出血的风险。

Objective This paper aims to explore the expression and clinical significance of insulin-like growth factor binding protein-3(IGFBP-3)in the serum of patients with hemorrhage from esophageal and gastric varices of liver cirrhosis.Methods A total of 242 patients with liver cirrhosis and rupture of esophageal and gastric varices who were treated in Suzhou Hospital of Integrated Traditional Chinese and Western Medicine from February 2017 to June 2018 were selected and assigned to the non-bleeding group(n=160)and the rebleeding group(n=82)according to whether or not they have rebleeding.The ELISA method was used to detect the expression of serum IGFBP-3 in patients and to analyze the relationship between serum IGFBP-3 and rebleeding.Results The expression of serum IGFBP-3 in the rebleeding group is higher than that in the non-bleeding group,with a statistically significant difference(P<0.05).The multivariate logistic regression analysis shows that Child-Pugh classification is grade C,and portal vein diameter,white blood cell count,and IGFBP-3 are independent risk factors for rebleeding after rupture of esophageal and gastric varices in liver cirrhosis(all P<0.05).Serum sodium is an independent protective factor for rebleeding after rupture of esophageal and gastric varices in liver cirrhosis(P<0.05).The area under the ROC curve(AUC),the sensitivity and specificity of IGFBP-3 in diagnosing rebleeding after rupture of esophageal,and the gastric varices in liver cirrhosis are 0.894,97.56%and 70.00%,respectively.A logistic regression model(composed of Child-Pugh grade,portal vein diameter,leukocyte count,blood sodium and IGFBP-3)was constructed to predict rebleeding after esophageal and gastric variceal bleeding in liver cirrhosis.The coincidence degree between the fitting curve and the ideal curve was high,and the consistency index(C index)was found to be 0.962.Conclusions The higher the expression of IGFBP-3 in the serum of patients with liver cirrhosis,esophageal and gastric varices bleeding,the higher the risk of rebleeding.The logistic regression model nomogram constructed by Child-Pugh classification,portal vein diameter,white blood cell count,blood sodium and IGFBP-3 can effectively assess the risk of rebleeding after rupture of esophageal and gastric varices in liver cirrhosis.