慢加急性乙型肝炎肝衰竭患者血浆脂联素水平的变化及其临床意义

Changes and clinical significance of plasma adiponectin in patients with hepatitis B virusrelated acute-on chronic liver failure

目的：探讨慢加急性乙型肝炎肝衰竭（hepatitis B virus-related acute-on chronic liver failure，HBV-A-CLF）患者血浆脂联素（adiponectin，ADPN）水平的变化及其临床意义。方法纳入 HBV-ACLF 患者82例，采用酶联免疫法检测血浆脂联素水平；依据患者住院30 d 的预后情况将患者分为生存组和死亡组，计算终末期肝病模型（model for end-stage liver disease，MELD）评分；采用多因素 Logistic 回归分析，探讨血清 ADPN 水平和 MELD 评分评估 HBV-ACLF 患者预后的价值。结果24例早期、30例中期和28例晚期 HBV-ACLF 患者血浆 ADPN 水平分别为（0.68±0.15）ng/ml，（0.76±0.17） ng/ml 和（0.89±0.18）ng/ml，随病程进展呈逐渐升高（F=12.30，P〈0.01）；30例生存患者性别、年龄、AST、ALT、白细胞、HBV DNA 载量等与52例死亡患者无显著性差异，但生存患者血清 ADPN和 MELD 评分分别为（0.7±0.2）ng/ml 和（26.3±6.4），均显著低于死亡患者[（0.82±0.18）ng/ml 和（37.9±8.1）， P〈0.01]；多因素 Logistic 回归分析显示血浆 ADPN 水平（OR=1.23，95%CI：1.12～1.34，P〈0.01）、MELD 评分（OR=1.43，95%CI：1.22～1.65，P〈0.01）、血清白蛋白（OR=1.18，95%CI：1.11～1.26，P〈0.01）及 AST/ALT 比值（OR=1.06，95%CI：1.01～1.11，P〈0.01）是影响 HBV-ACLF 患者近期预后的独立危险因素。结论 HBV-ACLF 患者血浆 ADPN 水平与肝功能损害程度有关，其水平升高提示患者近期预后不良。

Objective To investigate the changes and clinical significance of plasma adiponectin（ADPN） in patients with hepatitis B virus-related acute-on chronic liver failure （HBV-ACLF）. Methods Eighty-two patients with HBV-ACLF admitted to our department from Jan,2009 to Dec,2012 were included in this study. Clinical data were collected,and plasma ADPN was determined with ELISA. Patients were further divided into survival and dead group according to the clinical outcome at the end of 30 day hospitalization. The differences in plasma ADPN and model for end-stage liver disease （MELD） score between these two group were determined,and multi-variate logistic regression analysis was used to evaluate the significance of ADPN and MELD score in prognosis of short-term survival. Results The plasma levels of ADPN at early-stage （n=24）,middle-stage （n=30） and end-stage （n=28） of patients with HBV-ACLF were （0.68±0.15）ng/ml,（0.76±0.17） ng/ml and （0.89±0.18） ng/ml,re-spectively,which significantly increased with the progress of liver failure （F=12.30,P〈0.01）;No significant differ-ences as respect to gender,age,AST,ALT,white blood cells and HBV DNA load were observed between 30 sur-vival and 52 dead patients,however,the plasma ADPN and MELD scores in survival patients were （0.7±0.2）ng/ml and（26.3±6.4）,respectively,both significantly lower than those in dead patients[（0.82±0.18）ng/ml and（37.9±8.1）, respectively,P〈0.01];Multivariate logistic regression analysis showed that MELD score（OR=1.43,95%CI：1.22-1.65,P〈0.01）,plasma level of ADPN（OR=1.23,95%CI：1.12-1.34,P〈0.01）,serum albumin （OR=1.18,95%CI：1.11-1.26,P〈0.01） and AST/ALT ratio（OR=1.06,95%CI：1.01-1.11,P〈0.01） were independent risk factors for short-term prognosis in patients with HBV-ACLF. Conclusions Plasma level of ADPN is associated with the progress of liver dysfunc-tion,and an increase in plasma level of ADPN indicates a poor short-term prognosis in patients with HBV-ACLF.