血管性血友病因子水平联合MELD评分体系对肝硬化短期预后的预测价值

摘要/Abstract

摘要： 目的探讨血浆血管性血友病因子(vWF)水平与肝硬化严重程度的关系及其联合终末期肝病模型(MELD)评分体系对肝硬化患者短期预后的预测价值。方法随机收集2017年9月至2022年3月于上海交通大学医学院附属瑞金医院感染科住院的肝硬化患者共234例。检测所有患者的血浆vWF:Ag水平,收集相关临床数据。分析血浆vWF:Ag水平与MELD和MELD-Na评分的相关性,评估血浆vWF:Ag水平对肝硬化患者未来1个月和3个月发生死亡/肝移植的预测作用,构建vWF:Ag联合MELD改良评分,以期提高诊断价值。结果血浆vWF:Ag水平与MELD和MELD-Na评分均呈正相关,随两者的升高而升高(r=0.576和r=0.579,P均＜0.01)。分别有16.7%(29/174)和24.8%(38/153)的患者在其后1个月和3个月时发生死亡/肝移植。各时间点死亡/肝移植组患者的血浆vWF:Ag水平均显著高于非死亡/肝移植组(1个月非死亡/肝移植组vs死亡/肝移植组:(224.4±42.7)% vs (260.7±34.5)%,P<0.01;3个月非死亡/肝移植组vs死亡/肝移植组:(219.0±40.3)% vs(262.5±34.2)%,P<0.01)。多因素分析结果显示,血浆vWF:Ag水平是3个月死亡/肝移植的独立预测因素(OR=1.026,95%CI:1.006～1.046,P<0.01),其诊断的ROC曲线下面积(AUC)为0.795,略低于MELD评分的0.835和MELD-Na评分的0.851。构建vWF:Ag联合MELD-Na改良评分可将诊断的AUC提高至0.881。结论肝硬化患者的血浆vWF:Ag水平随肝病的严重程度而升高。血浆vWF:Ag水平是3个月死亡/肝移植的独立预测因素,vWF:Ag联合MELD-Na改良评分可进一步提高其诊断价值。

关键词: 血管性血友病因子, 肝硬化, 终末期肝病模型, 预后

Abstract: Objective To determine the relationship of plasma von Willebrand factor (vWF) level and the severity of liver cirrhosis and its predictive value when combined with the MELD scoring system in short-term prognosis. Methods A total of 234 cirrhotic patients who were hospitalized in Department of Infectious Diseases, Ruijin Hospital from September 2017 to March 2022 were initially enrolled. Plasma vWF:Ag levels were measured and clinical data were recorded. The correlations between plasma vWF:Ag level and MELD/MELD-Na scores were analyzed. Its predictive effect on 1-month and 3-month prognosis were evaluated. Results Plasma vWF:Ag levels were positively correlated with MELD and MELD-Na scores (r=0.576 and r=0.579, both P<0.01). Death／liver transplantation occurred in 16.7％(29/174) and 24.8％ (38/153) of patients at 1 and 3 months, respectively. Plasma vWF:Ag levels in higher mortality risk groups were both significantly higher than those in lower mortality risk groups (1 month, non-death/liver transplantation vs death/liver transplantation, 224.4±42.7％ vs 260.7±34.5%, P<0.01;3 months, non-death/liver transplantation vs death/liver transplantation, 219.0±40.3％ vs 262.5±34.2％, P<0.01). Multivariate analysis revealed that plasma vWF:Ag level was independently associated with 3-month death/liver transplantation (OR=1.026, 95％CI:1.006~1.046, P<0.01). Prediction of 3-month mortality risk was assessed by receiver operating characteristic curve (ROC-AUC). The diagnostic performance of MELD-Na score was slightly higher than those of MELD score and plasma vWF:Ag level in terms of 3-months outcome, which can be improved by of plasma vWF:Ag level incorporated into MELD-Na score as MELD-Na-vWF score (AUC:vWF:Ag, 0.795;MELD, 0.835;MELD-Na, 0.851;MELD-Na-vWF, 0.881). Conclusion Plasma vWF:Ag level increases with the severity of liver cirrhosis. vWF:Ag was an independent predictor of death／liver transplantation at 3 months. The addition of vWF-Ag to MELD-Na score improves prediction value.

Key words: von Willebrand Factor, Liver cirrhosis, Model for end-stage liver disease(MELD), Prognosis

庄焱, 林兰意. 血管性血友病因子水平联合MELD评分体系对肝硬化短期预后的预测价值[J]. 肝脏, 2023, 28(7): 759-763.

ZHUANG Yan, LIN lan-yi. The addition of von Willebrand factor to MELD scoring system improves prediction of short-term prognosis in liver cirrhosis[J]. Chinese Hepatolgy, 2023, 28(7): 759-763.

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