GCI和VITRO评分对乙型肝炎相关肝硬化患者静脉曲张出血的预测价值

Predictive value of GCI and VITRO scores for variceal bleeding in patients with hepatitis B-related cirrhosis

目的探讨糖萼素(GC)指数(GCI)和血管性血友病因子(vWF)与血小板比值(VITRO)评分在预测门静脉高压相关静脉曲张出血中的作用。方法纳入62例乙型肝炎相关肝硬化患者,至少随访12个月,所有患者均进行实验室检查和上消化道内镜检查。用ELISA法测定患者循环GC水平,用免疫比浊法测定vWF水平,并计算GCI和VITRO评分。用Spearman相关分析检验两变量间相关性。用多因素Cox回归模型预测随访期间新发静脉曲张出血的危险因素。用受试者工作特征(ROC)曲线确定最佳临界值,曲线下面积(AUC)比较预测价值。结果随访期间新发静脉曲张出血17例,无静脉曲张出血45例。出血患者的GCI和VITRO评分均高于未出血患者(P均<0.001)。GCI和VITRO评分与肝病严重程度相关,并与脾脏厚度和血肌酐呈正相关(P均<0.05)。多变量Cox回归分析确定GCI(风险比=1.39,95%置信区间:1.04~1.85,P=0.025)和VITRO(风险比=1.21,95%置信区间:1.03~1.41,P=0.017)是静脉曲张出血的显著预测因素。在临界值2.93和4.30水平下,GCI和VITRO评分可以预测静脉曲张出血,敏感性和特异性分别为88.24%和86.67%、82.35%和80.00%,AUC分别为0.893和0.842。结论GCI和VITRO评分是预测乙型肝炎相关肝硬化患者静脉曲张出血和风险分层的潜在无创生物标志物。

Objective To explore the scores of glycocalicin index(GCI)and von Willebrand factor antigen/platelet ratio(VITRO)for prediction of variceal bleeding in the patients with portal hypertension.Methods A total of 62 patients with hepatitis B-related liver cirrhosis were included,who were followed-up for at least 12 months.Laboratory examinations and upper gastrointestinal endoscopy were performed in all the patients.The levels of glycocalicin(GC)were measured by ELISA and von Willebrand factor(vWF)were measured by immunoturbidity,and GCI and VITRO scores were calculated.The correlations between two variables were analyzed with Spearman correlation analysis.Multivariate regression model was used to predict the risk factors for the new-onset variceal bleeding during the period of follow-up.The optimal cutoff value was determined by using receiver operating characteristic(ROC)curve analysis and the prediction values were compared by using area under curve(AUC).Results During the follow-up period,17 patients had new variceal bleeding and 45 patients had no variceal bleeding.The mean level of both GCI and VITRO score in the patients with variceal bleeding was higher than that of the patients without variceal bleeding(P<0.001).The GCI and VITRO score increased in parallel with the advancement of cirrhosis,and correlated with spleen thickness and creatinine level in serum(all P<0.05).Multivariate analysis showed that GCI(HR=1.39,95%CI:1.04-1.85,P=0.025)and VITRO(HR=1.21,95%CI:1.03-1.41,P=0.017)were independently correlated with variceal bleeding.At the threshold levels of 2.93 and 4.30,GCI VITRO scores could predict variceal bleeding with sensitivity of 88.24%and specificity of 86.67%for GCI,and 82.35%and 80.00%for the VITRO.The AUC was 0.893 and 0.842 respectively.Conclusion GCI and VITRO score should be potential noninvasive biomarkers for risk prediction and stratification of variceal bleeding in the patients with hepatitis B-related liver cirrhosis.