Mikuła Tomasz, Suchacz Magdalena M, Stańczak Wojciech, Jabłońska Joanna, Kozłowska Joanna, Cybula Aneta, Cianciara Janusz, Wiercińska-Drapało Alicja
Mild hyperbilirubinemia as a marker of oesophageal varices in HCV-related compensated cirrhotic patients.
Pol Merkur Lekarski. 2019 May 27;46(275):209-212.
The natural course of compensated liver cirrhosis caused by chronic hepatitis C virus (HCV) infection is still a very interesting problem in hepatology. The prognostic usefulness of the Child-Pugh and MELD score in compensated liver cirrhosis is still debated. Consequently, several attempts have been made to determine parameters other than included in the Child-Pugh score, which could be helpful in the prognosis of compensated liver cirrhosis assessment.
The aim of study was to identify a clinical or laboratory markers correlated with higher risk of liver decompensation among HCVinfected patients with compensated liver cirrhosis and presence or absence of esophageal varices.
The study included 176 HCV-infected patients with compensated liver cirrhosis (74 women and 102 men) registered in the Clinical Database of Patients with Liver Cirrhosis - e-Hepar. All patients were monitored during 252 weeks for the occurrence of liver failure symptoms and the development of hepatocellular carcinoma (HCC).
The presence of esophageal varices was significantly associated with total bilirubin ≥2.0 mg/dl, platelets ≤110.0 G/L and 6 points in Child-Pugh score (p<0.05). The cumulative 252 weeks incidence of clinical decompensation was higher in patients with varices in comparison to patients without them (p<0.05). Variceal hemorrhages were observed in 9 cases (23.1%). During the follow-up period 9 patients died due to HCC complications.
Our findings underline the prognostic value of serum bilirubin (even mild elevation) and platelet count in HCV-infected patients with compensated liver cirrhosis. We have confirmed that liver decompensation is more frequent and more rapid in patients with compensated liver disease and concomitant oesophageal varices.
慢性丙型肝炎病毒（HCV）感染所致代偿期肝硬化的自然病程仍是肝病学中一个非常有趣的问题。Child-Pugh评分和MELD评分在代偿期肝硬化中的预后价值仍存在争议。因此，人们已进行了多项尝试，以确定除Child-Pugh评分所包含参数之外的其他参数，这些参数可能有助于代偿期肝硬化评估的预后判断。
本研究的目的是在合并或不合并食管静脉曲张的HCV感染代偿期肝硬化患者中，确定与肝失代偿高风险相关的临床或实验室指标。
本研究纳入了176例登记在肝硬化患者临床数据库-e-Hepar中的HCV感染代偿期肝硬化患者（74例女性和102例男性）。所有患者在252周内接受监测，观察肝衰竭症状的发生及肝细胞癌（HCC）的发展情况。
食管静脉曲张的存在与总胆红素≥2.0mg/dl、血小板≤110.0G/L以及Child-Pugh评分为6分显著相关（p<0.05）。与无静脉曲张的患者相比，有静脉曲张的患者252周临床失代偿累积发生率更高（p<0.05）。观察到9例（23.1%）发生静脉曲张出血。在随访期间，9例患者死于HCC并发症。
我们的研究结果强调了血清胆红素（即使是轻度升高）和血小板计数在HCV感染代偿期肝硬化患者中的预后价值。我们已证实，合并食管静脉曲张的代偿期肝病患者肝失代偿更频繁且更迅速。
