| Objective To explore the clinical value of von Willebrand Factor(vWF)and VITRO score(vWF:Ag/platelet count)in assessing the disease progression of patients with HBV infection,and to provide evidence for distinguishing the compensatory and decompensated stages of hepatitis B cirrhosis.To study the clinical significance of vWF and VITRO scores with complications such as gastrointestinal bleeding and spontaneous peritonitis in patients with decompensated hepatitis B liver cirrhosis.Methods Randomly collect relevant clinical data of 308 patients with HBV infection(including 154 cases of chronic hepatitis B,66 cases of hepatitis B cirrhosis in compensatory period,88 cases of hepatitis B cirrhosis in decompensated period)from December 1,2018 to January 5,2021 in the Second Affiliated Hospital of Chongqing Medical University.The vWF values are measured by a uniform optical method,and all data are included using a uniform standard.Analyze the difference and significance of plasma vWF level and VITRO score in chronic hepatitis B,hepatitis B cirrhosis in the compensatory phase and decompensated phase.Results 1.Plasma vWF level and VITRO score increased with the disease progression of HBV infected patients,the difference was statistically significant(P<0.001 and P<0.001),and their values were respectively in the chronic hepatitis B group(139.47±76.44 and0.86±0.8),Hepatitis B liver cirrhosis compensatory group(164.95±67.12 and 1.44±1.14),hepatitis B liver cirrhosis decompensated group(317.48±103.32 and 6.81±4.98).2.Plasma vWF level and VITRO score in patients with hepatitis B liver cirrhosis increased with the increase of Child-Pugh classification grade,the difference was statistically significant(P<0.001 and P<0.001),and their values were the A-level group(185.65± 85.07 and 2.3±2.37),B-level group(304.74±105.81 and6.37±5.19),C-level group(369.48±73.23 and 8.28±5.38).3.The AUC of vWF level and VITRO score for diagnosing decompensated hepatitis B liver cirrhosis were 0.897(95% CI: 0.855～0.940,P<0.01)and 0.949(95%CI: 0.916～0.982,P<0.01).When the cutoff values of vWF level and VITRO score are 238.55% and 1.65,respectively,the sensitivity for diagnosing decompensated hepatitis B cirrhosis is 79.5% and 94.3%,the specificity is 92.3% and 87.7%,and the positive predictive value is80.5% And 94.3%,the negative predictive values were 91.9% and 97.5%,and the diagnostic accuracy rates were 88.6% and 89.3%.4.Among patients with decompensated hepatitis B liver cirrhosis,the vWF level of the gastrointestinal bleeding group(367.24±68.29)was significantly higher than that of the no gastrointestinal bleeding group(286.15±109.69),and the difference was statistically significant(P<0.001);The VITRO score of the gastrointestinal bleeding group(9.12±5.4)was significantly higher than that of the group without gastrointestinal bleeding(5.36±4.13),and the difference was statistically significant(P<0.01).The level of vWF in the group with spontaneous peritonitis(341.73±87.92)was higher than that in the group without spontaneous peritonitis(296.32±111.74),and the difference was statistically significant(P<0.05),while the difference in VITRO score between the two groups was not statistically significant.Conclusion The plasma vWF level and VITRO score gradually increased with the progression of liver disease in patients with HBV infection,and both were positively correlated with the Child-Pugh classification of patients with hepatitis B cirrhosis.When vWF≥238.5%or VITRO score≥1.65,it indicates that hepatitis B liver cirrhosis is more likely to be decompensated.Among them,vWF has higher specificity and VITRO score is more sensitive.In patients with decompensated hepatitis B liver cirrhosis,the vWF and VITRO scores of those with gastrointestinal bleeding were higher than those without gastrointestinal bleeding,the vWF with spontaneous peritonitis was higher than those without spontaneous peritonitis,and vWF was better than the VITRO score.This has certain guiding significance for intervention measures as early as possible. |
PDF Full Text Request