vWF相关指标在诊断乙肝患者肝硬化进展中的价值

doi:10.16150/j.1671-2870.2024.06.003

摘要/Abstract

摘要：

目的： 评估血管性血友病因子（von Willebrand factor，vWF）及其相关指标与乙肝患者肝硬化进展的相关性，并探讨vWF相关指标辅助诊断乙肝患者肝硬化失代偿的断价值。方法： 收集2020年12月至2021年3月上海交通大学医学院附属瑞金医院感染科连续收治的乙肝住院患者共计91例。根据肝硬化诊断标准，将患者分为慢性乙肝组（31例），乙肝肝硬化代偿期组（18例），乙肝肝硬化失代偿期组（42例）。采用ELISA法检测 vWF抗原水平（vWF antigen level, vWF:Ag）、vWF与胶原结合能力（vWF collagen-binding capacity， vWF:CB）以及vWF前肽（vWF propeptide, vWFpp）水平。以vWF:CB/vWF:Ag比值反映不同分子量的vWF多聚体分布情况，以vWFpp/vWF:Ag比值反映vWF在体内的清除速率，以vWF:Ag/血小板计数比值计算VITRO评分。使用SPSS 26.0软件进行组间比较、相关性分析，并评估各指标对乙肝肝硬化失代偿的诊断效能。结果： 乙肝肝硬化失代偿组血浆vWF:Ag、vWF:CB、vWFpp和vWFpp/vWF:Ag水平显著高于乙肝肝硬化代偿组，而vWF:CB/vWF:Ag水平和VITRO评分在两组间无显著差异。vWF:Ag、vWF:CB、vWFpp与慢性乙肝感染患者Child-Pugh评分呈中度正相关，r值分别为0.604、0.593、0.711（P<0.05）。当vWFpp临界值设为大于305.5%时，其对乙肝肝硬化失代偿的诊断效能最高，灵敏度为78.6%，特异度为93.9%，阳性预测值91.7%，阴性预测值83.6%，诊断准确率86.8%，曲线下面积0.899。结论： 血浆vWF:Ag、vWFpp水平与慢性乙肝患者Child-Pugh肝功能分级间相关性较好，可用于辅助诊断慢性乙肝肝硬化失代偿，指导患者治疗。

关键词: 血管性血友病因子, 乙型肝炎病毒, Child-Pugh肝功能评分, 肝硬化失代偿

Abstract:

Objective To evaluate the correlation between von Willebrand factor (vWF) and its related indicators and the progression of liver cirrhosis in patients with hepatitis B and explore the diagnostic value of vWF-related indicators in assisting the diagnosis of decompensated liver cirrhosis in patients with hepatitis B.Methods A total of 91 hepatitis B patients hospitalized in the Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from December 2020 to March 2021, were included. According to the diagnostic criteria for liver cirrhosis, the patients were divided into three groups: chronic hepatitis B group (31 cases), compensated hepatitis B cirrhosis group (18 cases), and decompensated hepatitis B cirrhosis group (42 cases). The vWF antigen level (vWF: Ag), vWF collagen binding activity (vWF: CB), and vWF propeptide (vWFpp) were measured by ELISA. The vWF: CB/ vWF: Ag ratio was used to reflect the distribution of vWF multimers of different molecular weights. The vWFpp/vWF: Ag ratio was used to reflect the clearance rate of vWF in vivo. The ratio of vWF: Ag/platelet count was used to calculate the VITRO score. The SPSS 26.0 software was used for intergroup comparison, correlation analysis, and to assess the diagnostic performance of each indicator for decompensated hepatitis B cirrhosis.Results The levels of plasma vWF: Ag, vWF: CB, vWFpp, and vWFpp/vWF: Ag were significantly higher in the decompensated hepatitis B cirrhosis group than in the compensated group. However, there were no significant differences in the ratio of vWF: CB/vWF: Ag and VITRO scores between the two groups. The vWF: Ag, vWF: CB and vWFpp showed moderate positive correlations with Child-Pugh score in patients with chronic hepatitis B, with r values of 0.604, 0.593, and 0.711, respectively (P<0.05). When the cut-off value of vWFpp was set over 305.5%, its diagnostic efficacy for decompensated hepatitis B cirrhosis was highest, with a sensitivity of 78.6%, specificity of 93.9%, positive predictive value of 91.7%, negative predictive value of 83.6%, diagnostic accuracy of 86.8%, and area under the curve of 0.899.Conclusion The levels of vWF: Ag and vWFpp in plasma are well correlated with Child-Pugh liver function classification in patients with chronic hepatitis B, and can be used to assist in the diagnosis of decompensated liver cirrhosis of chronic hepatitis B, guiding patient treatment.

Key words: Von Willebrand factor, Hepatitis B, Child-Pugh liver function score, Decompensated liver cirrhosis

中图分类号:

R575.2
R446

杨铭康, 刘禹, 许冠群, 王剑飚, 王学锋, 梁茜. vWF相关指标在诊断乙肝患者肝硬化进展中的价值[J]. 诊断学理论与实践, 2024, 23(06): 574-579.

YANG Mingkang, LIU Yu, XU Guanqun, WANG Jianbiao, WANG Xuefeng, LIANG Qian. Value of vWF-related indicators in the diagnosis of liver cirrhosis progression in patients with hepatitis B[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(06): 574-579.

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参考文献 21

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Index	Chronic Hepatitis B (n=31)	Compensated cirrhosis (n=18)	Decompensated cirrhosis (n=42)	Reference range	Statistical value	P
Age (year，M(QR))	47(38-63)	52(46-57)	56(45-62)	/	H=2.079	0.354
Sex (male/female)	23/8	17/1	36/6	/	X²=83.583	0.209
INR	1.10(1.06-1.26)	1.34(1.17-1.72)	1.55(1.29-1.97)	/	H=31.238	<0.001
PLT [×10⁹/L, M (QR)]	128(80-165)	68(40-106)	74(55-125)	125-350	H=15.279	<0.001
ALT [U/L, M (QR)]	47(25-88)	57(28-113)	44(19-126)	9-50	H=0.885	0.642
AST [U/L, M (QR)]	43(29-72)	75(34-179)	74(34-210)	15-40	H=6.043	0.049
ALP [U/L, M (QR)]	104(90-141)	124(94-161)	131(91-166)	45-125	H=1.420	0.492
γ-GT [U/L, M (QR)]	78(38-153)	80(33-103)	55(29-107)	10-60	H=1.738	0.419
TP [U/L, M (QR)]	64(57-69)	62(58-69)	58(55-64)	60-83	H=5.165	0.076
Alb [g/L, M (QR)]	35(32-42)	34(30-37)	30(27-33)	35-55	H=15.439	<0.001
TBil [μmol/L, M (QR)]	24.0(14.0-78.0)	51.7(27.3-225.7)	86.6(37.0-337.8)	4.7-24.0	H=15.038	<0.001
vWF:Ag [%, M (QR)]	147.6(99.7-211.7)	212.4(154.7-229.1)	275.9(194.8-360.0)	50.0-150.0	H=29.650	<0.001
vWF:CB [%, M (QR)]	135.2(94.4-190.2)	182.0(163.1-221.2)	251.8(203.0-290.7)	50.0-150.0	H=32.569	<0.001
vWFpp [%, M (QR)]	131.7(181.3-226.0)	230.9(161.2-286.7)	451.1(319.2-614.0)	50.0-150.0	H=45.388	<0.001
vWF:CB/vWF:Ag	0.90(0.84-0.99)	0.96(0.83-1.07)	0.90(0.83-0.94)	0.80-1.20	H=1.997	0.369
vWFpp/vWF:Ag	1.07(0.89-1.50)	1.07(0.98-1.35)	1.57(1.27-1.93)	0.80-1.20	H=19.832	<0.001
VITRO	1.18(0.66-1.65)	3.13(1.93-4.60)	3.33(2.18-5.56)	/	H=30.612	<0.001

Index	Correlation analysis
Index	r	P
vWF:Ag	0.604	<0.001
vWF:CB	0.593	<0.001
vWFpp	0.711	<0.001
vWF:CB/vWF:Ag	-0.235	0.025
vWFpp/vWF:Ag	0.411	<0.001
VITRO	0.423	<0.001

Index	Cut-off value	Sensitivity(%)	Specificity(%)	PPV(%)	NPV(%)	Accuracy（%）	AUC	P
vWF:Ag	234.4	66.7	85.7	80.0	75.0	76.9	0.809	<0.001
vWF:CB	204.5	76.2	81.6	78.0	80.0	79.1	0.821	<0.001
vWFpp	305.5	78.6	93.9	91.7	83.6	86.8	0.899	<0.001
vWFpp/vWF:Ag	1.34	73.8	73.5	70.5	76.6	73.6	0.772	<0.001
VITRO	2.52	73.8	71.4	68.9	76.1	72.5	0.753	<0.001