血清层粘连蛋白、Ⅳ型胶原蛋白对代偿期肝硬化食管胃静脉曲张出血的预测价值

Predictive value of serum laminin and typeⅣcollagen on liver cirrhosis with ophageal and gastric varices bleeding

目的探究血清层粘连蛋白(LN)、Ⅳ型胶原蛋白(Ⅳ-C)对代偿期肝硬化食管胃静脉曲张出血(EVB)的预测价值。方法选取2021年11月至2022年11月保定市人民医院就诊104例代偿期肝硬化患者为研究对象,以临床症状和胃镜检查结果为依据将其分为EVB组(n=50例)和非EVB组(n=54例)。对比两组入院时血清LN、Ⅳ-C水平及MELD评分差异,绘制ROC曲线分析LN、Ⅳ-C水平对代偿期肝硬化患者EVB发生的预测效能;Pearson相关系数分析EVB组患者入院时LN、Ⅳ-C水平与MELD评分间相关性。以MELD评分为依据将EVB组患者分为预后良好亚组(MELD评分≤14分)和预后不良亚组(MELD评分>14分),ROC曲线分析入院时血清LN、Ⅳ-C水平对代偿期肝硬化合并EVB患者预后的预测效能。结果入院时,EVB组患者血清LN、Ⅳ-C水平、MELD评分均显著高于非EVB组(P<0.05);ROC曲线结果显示,入院时血清LN、Ⅳ-C水平预测代偿期肝硬化患者EVB发生的曲线下面积(AUC)分别为0.784、0.804(P<0.05);Pearson相关分析显示,合并EV的代偿期肝硬化患者入院时LN、Ⅳ-C水平与MELD评分有显著正相关性(P<0.05)。预后良好亚组入院时血清LN、Ⅳ-C水平均显著低于预后不良亚组(P<0.05);ROC曲线分析显示,入院时血清LN、Ⅳ-C水平预测代偿期肝硬化合并EVB患者预后的AUC分别为0.737、0.714(P<0.05)。结论血清LN、Ⅳ-C水平对于代偿期肝硬化患者EVB发生以及预后评估均具有较高预测价值。

Objective To explore the predictive value of serum laminin(LN)and typeⅣcollagen(Ⅳ-C)on liver cirrhosis with ophageal and gastric varices bleeding(EVB).Methods A total of 104 patients with compensated liver cirrhosis who were treated in Baoding People′s Hospital from November 2021 to November 2022 were selected as the study subjects.The patients were divided into EVB group(n=50)and non-EVB group(n=54)according to the clinical symptoms and gastroscopy results.Serum LN andⅣ-C levels and MELD score were compared between the two groups at admission,and ROC curve was drawn to analyze the predictive efficiency of serum LN andⅣ-C levels on EVB occurrence in patients with compensated liver cirrhosis.Pearson correlation coefficient was used to analyze the correlation between LN andⅣ-C levels at admission and MELD score in EVB group.With MELD score as basis,patients in the EVB group were classified into good prognosis subgroup(MELD score≤14 points)and poor prognosis subgroup(MELD score>14 points).ROC curve was applied to analyze the predictive efficiency of serum LN andⅣ-C levels at admission on prognosis in patients with compensated liver cirrhosis complicated with EVB.Results At admission,serum LN andⅣ-C levels and MELD score in the EVB group were significantly higher than those in the non-EVB group(P<0.05).ROC curve results showed that the areas under the curve(AUC)of serum LN andⅣ-C levels at admission in predicting EVB occurrence in patients with compensated liver cirrhosis were 0.784 and 0.804,respectively(P<0.05).Pearson correlation coefficient revealed that LN andⅣ-C levels at admission were significantly positively correlated with MELD score in depatients with compensated liver cirrhosis and EVB(P<0.05).The levels of serum LN andⅣ-C at admission in the good prognosis subgroup were significantly lower than those in the poor prognosis subgroup(P<0.05).ROC curve analysis revealed that the AUC of serum LN andⅣ-C levels at admission in predicting prognosis in patients with compensated liver cirrhosis complicated with EVB were 0.737 and 0.714,respectively(P<0.05).Conclusion Serum LN andⅣ-C levels have high predictive value on the EVB occurrence and prognosis evaluation in depatients with compensated liver cirrhosis.