Objective: To explore the clinical value of von Willebrand Factor (vWF) and VITRO score (vWF:Ag/platelet count) in assessing disease progression in patients with HBV infection. 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: The plasma vWF level and VITRO score of the chronic hepatitis B group were (139.47±76.44) and (0.86±0.8), respectively, and the hepatitis B cirrhosis compensated group was (164.95±67.12 and 1.44±1.14), respectively. Hepatitis cirrhosis decompensated group were (317.48±103.32 and 6.81±4.98), respectively; plasma vWF level and VITRO score increased with the progression of HBV infection, and the difference was statistically significant (F=133.669,P=0.000F=137.598,P=0.000).The plasma vWF level and VITRO score in patients with hepatitis B cirrhosis were (185.65±85.07 and 2.3±2.37) in the Child-Pugh A group, (304.74±105.81 and 6.37±5.19) in the B grade group, and (369.48±73.238.28±5.38) in the C grade group; plasma vWF level and VITRO score in patients with hepatitis B cirrhosis increased with the increase of Child-Pugh grade, and the difference was statistically significant (F=60.236, P=0.000F=32.854, P=0.000). The area under the curve (AUC) of plasma vWF level and VITRO score for diagnosing the decompensated stage of hepatitis B cirrhosis were 0.897 [95% confidence interval (CI): 0.855-0.940, P＜0.01], 0.949 [95% CI: 0.916-0.982, P＜0.01). When the vWF level and VITRO score were taken as cut-off values of 238.5% and 1.65, respectively, the sensitivity of diagnosing the decompensated stage of hepatitis B cirrhosis was 79.5% and 94.3%, the specificity was 92.3% and 87.7%, and the positive predictive value was 80.5% and 94.3%, the negative predictive value was 91.9% and 97.5%, and the diagnostic accuracy was 88.6% and 89.3%. Among the patients with decompensated hepatitis B cirrhosis, the level of vWF in the group with gastrointestinal bleeding (367.24±68.29)% was significantly higher than that in the group without gastrointestinal bleeding (286.15±109.69)%, and the difference was statistically significant (P＜0.001) The VITRO score of the group with gastrointestinal bleeding (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 vWF level in the spontaneous peritonitis group was (341.73±87.92)% higher than that in the non-spontaneous peritonitis group (296.32±111.74)%, and the difference was statistically significant (P＜0.05). There was no statistical difference in VITRO score between the two groups. significance. Conclusion: Plasma vWF level and VITRO score can evaluate the progression of liver disease and the degree of decompensation of liver cirrhosis in patients with HBV infection, and have a predictive effect on various complications after decompensation of liver cirrhosis, and have certain guiding significance for early intervention measures.
目的： 探讨血管性血友病因子（vWF）及VITRO评分（vWF/血小板计数数值的比值）评估乙型肝炎病毒（HBV）感染患者疾病进展的临床价值。 方法： 随机收集重庆医科大学附属第二医院2018年12月1日—2021年1月5日308例HBV感染患者（包括154例慢性乙型肝炎、66例乙型肝炎肝硬化代偿期、88例乙型肝炎肝硬化失代偿期）的相关临床数据，vWF数值均采用统一的光学法测定，所有数据均使用统一标准纳入，并分析血浆vWF水平及VITRO评分在慢性乙型肝炎、乙型肝炎肝硬化代偿期及失代偿期各组中的差别及意义。 结果： 慢性乙型肝炎组的血浆vWF水平及VITRO评分数值分别为（139.47%±76.44%、0.86±0.8），乙型肝炎肝硬化代偿期组分别为（164.95%±67.12%和1.44±1.14）、乙型肝炎肝硬化失代偿期组分别为（317.48%±103.32%和6.81±4.98）；血浆vWF水平及VITRO评分随HBV感染患者疾病进展而增高，差异有统计学意义（F值分别为133.669、137.598，P值均<0.001）。乙型肝炎肝硬化患者中血浆vWF水平及VITRO评分数值在Child-Pugh A级组分别为（185.65%±85.07%和2.3±2.37）、B级组为（304.74%±105.81%和6.37±5.19）、C级组为（369.48%±73.23%和8.28±5.38）；乙型肝炎肝硬化患者中血浆vWF水平及VITRO评分随着Child-Pugh分级等级的增高而增高，差异有统计学意义（F值分别为60.236、32.854，P值均<0.001）。血浆vWF水平及VITRO评分诊断乙型肝炎肝硬化失代偿期的曲线下面积（AUC）分别为0.897［95％可信区间（CI）：0.855～0.940，P＜0.01］、0.949［95％CI：0.916～0.982，P＜0.01］。vWF水平及VITRO评分分别取界值为238.5％和1.65时，诊断乙型肝炎肝硬化失代偿期的敏感度分别为79.5%和94.3%，特异度为92.3%和87.7%，阳性预测值为80.5％和94.3%，阴性预测值为91.9%和97.5%，诊断准确率为88.6%和89.3％。乙型肝炎肝硬化失代偿期患者中，有消化道出血组vWF水平为367.24%±68.29%显著高于无消化道出血组的286.15%±109.69%，差异有统计学意义（P＜0.001）；有消化道出血组VITRO评分为9.12±5.4明显高于无消化道出血组的5.36±4.13，差异有统计学意义（P＜0.01）。有自发性腹膜炎组vWF水平为341.73%±87.92%高于无自发性腹膜炎组的296.32%±111.74%，差异有统计学意义（P＜0.05），而VITRO评分在两组中比较，差异无统计意义。 结论： 血浆vWF水平及VITRO评分可评估HBV感染患者肝脏疾病进展程度及肝硬化失代偿期程度，且对肝硬化失代偿后各种并发症有预测作用，对尽早作出干预措施有一定指导意义。.