Clinical Significance And Analysis Of Serum VEGF Expression In Budd-Chiari Syndrome And Budd-Chiari Syndrome Complicated With Hepatocellular Carcinoma

ObjectiveTo investigate factors related to serum VEGF expression in patients with Budd-Chiari syndrome(BCS),and the clinical significance of serum expression of VEGF in patients with BCS and patients with BCS complicated with hepatocellular carcinoma.Methods1.The detailed information of 72 cases of BCS treated in our department from January 2018 to April 2020 was searched in the electronic medical record system,Among them,59 patients with simple BCS(12 patients with inferior vena cava type BCS,12 patients with hepatic vein type BCS,and 35 patients with mixed type BCS)were included in the BCS group,and 13 patients with BCS complicated with hepatocellular carcinoma were included in the BCS complicated with hepatocellular carcinoma group.At the same time,34 patients with gallstones who visited the department during the same period were randomly selected as the control group.2.Detailed examination data of these people are available in the new and old versions of electronic medical record system and PACS system of our hospital.We recorded age,sex,type,course of disease,blood routine,serum VEGF level,liver function,coagulation function,renal function,AHV diameter,ascites,and occurrence of hepatic encephalopathy in patients with BCS and BCS complicated with hepatocellular carcinoma,and recorded age,sex,and serum VEGF level in control group.Clinical diagnosis and Child-Pugh grading were made according to relevant indexes.3.SPSS21.0 software was used for statistical analysis of all research data,and chi-square test was used for qualitative data processing.The measurement data are expressed as x±s,and the independent sample t test is used to compare the parameters between the two groups;single factor analysis of variance.is used to compare the parameters between groups,and SNK-q test is used when the variance of pairwise comparison between groups is the same,otherwise,Dunnett’s T test is used.Spearman correlation analysis was used for correlation analysis,and linear regression was used for significance test.Results1.The serum VEGF expression level of 59 patients in BCS group was 34.80～376.46pg/mL,with an average of(187.22±72.36)pg/mL.Serum VEGF expression levels were 264.30～495.73pg/mL in 13 patients with BCS complicated with hepatocellular carcinoma,with an average(395.90±67.42)pg/mL.In 34 cases of control group,the serum VEGF level was 24.80～121.10pg/mL,with an average of(66.45±29.18)pg/mL.There was no significant difference in age and sex among the three groups(P>0.05).The serum VEGF level in BCS complicated with hepatocellular carcinoma group was higher than that in BCS group,and that in BCS group was higher than that in control group(P<0.01).2.There were 59 patients in BCS group and 13 patients in BCS complicated with hepatocellular carcinoma group.There was no significant difference in age,male proportion,BCS classification,platelet count,serum creatinine,international normalized ratio(INR),prothrombin time(PT),serum total protein,serum bilirubin,ascites,hepatic encephalopathy,Child-Pugh score and Child-Pugh grade between the two groups(P>0.05).However,in terms of serum VEGF level,ALT level,AST level,course of disease,diameter of AHV,BCS complicated with hepatocellular carcinoma group was significantly larger(P<0.05).To evaluate the cut-off value of serum VEGF in the diagnosis of BCS complicated with hepatocellular carcinoma,the sensitivity and specificity of serum VEGF in the diagnosis of BCS complicated with HCC were 92.3%and 88.1%when the cut-off value was 276.25pg/mL(AUROC=0.98).3.There were no significant differences in age,course of disease,ALT level and AST level among three types of BCS group(P>0.05).There was no significant difference in their gender distribution(X2=1.054,P=0.590).The expression of VEGF in patients with inferior vena cava and mixed BCS was higher than that in patients with hepatic vein BCS(P<0.05),but interestingly,there was no difference between patients with inferior vena cava and mixed BCS(P>0.05).There were significant differences in AHV diameter among different types of BCS.The sum of AHV diameters in patients with mixed BCS was larger than that in patients with inferior vena cava BCS,and the sum of AHV diameters in patients with inferior vena cava BCS was larger than that in patients with hepatic vein BCS(P<0.05).4.Correlation analysis showed that serum ALT and AST levels were not correlated with VEGF expression(P>0.05).The correlation between BCS classification and VEGF expression was weak(p<0.4),but the correlation between disease duration and VEGF expression was moderate(p=0.558),and the sum of AHV diameter was positively correlated with VEGF expression(p=0.646).The results of linear regression analysis showed that the longer the course of disease,the higher the expression level of serum VEGF(F=38.751,P<0.001),the higher the expression level of VEGF,the larger the inner diameter of AHV(F=48.228,P<0.001).ConclusionThe serum VEGF expression level of the patients increased with the extension of the course of disease,and the inner diameter of AHV widened with the increase of serum VEGF expression level.Patients with BCS with a longer course of disease and a serum VEGF level greater than 276.25pg/mL have an increased risk of developing HCC.