失代偿期肝硬化患者血清vWF、TSP-1表达与短期预后的关系分析

Relationship between serum vWF,TSP-1 expression and short-term prognosis in patients with decompensated liver cirrhosis

目的分析失代偿期肝硬化患者血清血管性假血友病因子(vWF)、凝血酶敏感蛋白-1(TSP-1)表达水平,探讨两者与患者短期预后的关系。方法回顾性选取2017年8月至2019年8月四川省第三人民医院收治的115例失代偿期肝硬化患者,按生存结局分存活组83例和死亡组32例。收集所有患者一般资料及首次入院后实验室检查指标[血清胆红素、白蛋白、肌酐、凝血酶原时间国际标准化比值(INR)、凝血酶原时间(PT)、Child-Pugh评分、终末期肝病模型(MELD)评分]。采用酶联免疫吸附试验法检测并比较血清vWF、TSP-1水平;采用COX危险因素分析影响失代偿期肝硬化患者短期死亡的因素;绘制受试者工作特征曲线(ROC)分析血清vWF、TSP-1表达对急性失代偿期肝硬化患者短期死亡的诊断价值。结果死亡组患者胆红素、肌酐、INR、PT、Child-Pugh评分、MELD评分、血清vWF、TSP-1水平为(95.58±25.36)μmol/L、(1.62±0.63)mg/dL、2.98±0.97、(148.79±42.68)s、(10.87±2.69)分、(23.66±6.83)分,(2.51±0.38)ng/mL、(1.89±0.27)ng/mL,均显著高于存活组[(35.77±10.89)μmol/L、(0.82±0.31)mg/dL、1.65±0.62、(129.77±28.06)s、(8.92±1.93)分、(14.39±4.87)分、(1.50±0.23)ng/mL、(1.13±0.16)ng/mL],白蛋白水平为(6.75±2.37)g/L,显著低于存活组[(28.62±8.77)g/L],差异均有统计学意义(P<0.05)。多因素COX分析显示,vWF、TSP-1水平高是急性失代偿期肝硬化患者死亡的危险因素(HR=3.785、2.961,P<0.05)。ROC曲线显示,血清vWF、TSP-1诊断失代偿期肝硬化患者短期预后不良的曲线下面积(AUC)分别为0.857、0.839,两者联合检测诊断AUC为0.936。结论血清vWF、TSP-1异常高表达可能与失代偿期肝硬化患者短期预后不良有关,两者联合检测对失代偿期肝硬化患者短期预后不良有较高诊断效能,可为临床早期评估患者预后提供依据。

Objective To analyze the expression levels of serum von Willebrand factor(VWF)and thrombin sensitive protein-1(TSP-1)in patients with decompensated liver cirrhosis,and to explore the relationship between them and short-term prognosis.Methods A total of 115 patients with decompensated liver cirrhosis treated from August 2017 to August 2019 were divided into 83 cases in the survival group and 32 cases in the death group according to survival outcome.General information of all patients and laboratory test indexes after first admission[serum bilirubin,albumin,creatinine,international normalized ratio(INR)of prothrombin time,prothrombin time(PT),Child-Pugh score,end-stage liver disease model(MELD)score]were collected.The levels of serum vWF and TSP-1 were detected by enzyme-linked immunosorbent assay(ELISA);influencing factors of short-term mortality in patients with decompensated cirrhosis were analyzed using COX risk factors;the diagnostic value of serum vWF and TSP-1 expression in patients with acute decompensated liver cirrhosis were analyzed by receiver operating characteristic curve(ROC).Results The levels of serum bilirubin,creatinine,INR,PT,Child-Pugh score,MELD score,serum vWF and TSP-1 in the death group were(95.58±25.36)μmol/L,(1.62±0.63)mg/dL,2.98±0.97,(148.79±42.68)s,(10.87±2.69)points,(23.66±6.83)points,(2.51±0.38)ng/mL,(1.89±0.27)ng/mL,which were significantly higher than the survival group[(35.77±10.89)μmol/L,(0.82±0.31)mg/dL,1.65±0.62,(129.77±28.06)s,(8.92±1.93)points,(14.39±4.87)points,(1.50±0.23)ng/mL,(1.13±0.16)ng/mL],the level of albumin was(6.75±2.37)g/L,which was significantly lower than the survival group[(28.62±8.77)g/L],the differences were statistically significant(P<0.05).Multivariate COX analysis showed that high levels of vWF and TSP-1 were the risk factors of death in patients with acute decompensated liver cirrhosis(HR=3.785,2.961,P<0.05).ROC curve showed that the area under the curve(AUC)of serum vWF and TSP-1 in the diagnosis of decompensated liver cirrhosis with poor short-term prognosis was 0.857 and 0.839,respectively,the AUC of the combined diagnosis was 0.936.Conclusion The abnormal high expression of serum vWF and TSP-1 may be related to the poor short-term prognosis of patients with decompensated liver cirrhosis.The combined detection of vWF and TSP-1 has high diagnostic efficiency for the short-term poor prognosis of patients with decompensated liver cirrhosis,and it can provide the basis for early clinical evaluation of the prognosis of patients.