关键词: 肝硬化上消化道出血, 维生素B12, β-抑制蛋白2, 病情严重程度, 预后

Abstract: Objective To investigate the correlation between the levels of serum vitamin B12 (VB12) and β-arrestin2 with the severity and prognosis of liver cirrhotic patients with upper gastrointestinal bleeding. Methods From December 2020 to December 2023, 102 patients with upper gastrointestinal bleeding due to liver cirrhosis admitted to our hospital were collected. Serum VB12 and β-arrestin2 levels were detected with enzyme linked immunosorbent assay (ELISA). The factors influencing the severity of condition and prognosis were analyzed with logistic regression methods. The predictive value of serum VB12 and β-arrestin2 levels on prognosis was analyzed with receiver operating characteristic (ROC) curve method. Spearman method was applied to analyze the correlation between the levels of VB12 and β-arrestin2 with the severity of condition, gradings of liver function, and scores of Model End-Stage Liver Disease (MELD) of the patients. Results Compared with the mild group, the VB12 levels in the moderate and severe groups increased [(498.65±51.26 vs. 539.28±54.58 and 597.22±61.38), P<0.001], whereas the β-arrestin2 level decreased [(241.35±26.71 vs. 219.37±25.89 and 187.05±21.94), P<0.001]. The VB12 level in the severe group was higher than that in the moderate group, whereas the β-arrestin2 level was lower than that in the moderate group (P<0.05); VB12 [OR(95%CI):1.388(1.130~1.705), P=0.002] was a risk factor that affected the severity of the patient′s condition, On the contrary, β-arrestin2 [OR(95%CI)=0.588(0.387~0.894), P=0.013], hemoglobin [OR(95%CI)=0.764(0.603~0.968), P=0.026], prothrombin time (PT) [OR(95%CI)=0.788(0.645~0.962), P=0.019], platelets [OR(95%CI)=0.851(0.736~0.984), P=0.029], and fibrinogen [OR(95%CI)=0.851(0.736~0.984), P=0.029] levels were protective factors that affected the severity of the patient′s condition. There were statistically significant differences in liver function grading [(7.05±0.71 vs. 9.65±1.02), P<0.001], MELD score [(13.36±1.48 vs. 16.98±1.79), P<0.001], hemoglobin [(81.65±8.62 vs. 74.68±7.49), P<0.001], PT [(86.35±8.97 vs. 82.49±8.36), P=0.042], fibrinogen [(84.22±8.54 vs. 75.62±7.86), P<0.001, and serum VB12 [(510.32±52.41 vs. 593.66±59.95), P<0.001] and β-arrestin2 [(233.59±27.98 vs. 192.32±19.68), P<0.001] levels between the improvement group and the deterioration group; among them, VB12 [OR(95%CI)=1.974(1.193~3.267), P=0.008] was a risk factor that affected deterioration, whereas β-arrestin2 [OR(95%CI)=0.527(0.294~0.945), P=0.032], hemoglobin [OR(95%CI)=0.584(0.353~0.966), P=0.036], and fibrinogen [OR(95%CI)=0.697(0.512~0.948), P=0.021] levels were protective factors that affected deterioration; the AUC of VB12, β-arrestin2, and their combination in predicting prognosis was 0.854, 0.847, and 0.922, respectively, the combined prediction was better than VB12 (Z=2.154, P=0.031) and β-arrestin2 (Z=2.111, P=0.035) alone. VB12 level was positively correlated with liver function grading, disease severity, and MELD score (r=0.409, 0.425, 0.471, P<0.05). On the contrary, β-arrestin2 was negatively correlated with liver function grading, disease severity, and MELD score (r=-0.422, -0.467, -0.430, P<0.05). Conclusion In patients with upper gastrointestinal bleeding caused by liver cirrhosis, serum VB12 level increases whereas β-arrestin2 level decreases. The expression of both is correlated with the severity and prognosis of the patient′s condition.

Key words: Upper gastrointestinal bleeding caused by liver cirrhosis, Vitamin B12, β-arrestin2, Severity of condition, Prognosis