血清基质金属蛋白酶-2对肝衰竭的预测分析

Analysis of the predictive value of serum matrix metalloproteases-2 for liver failure

目的探讨血清基质金属蛋白酶(MMP)-2对肝衰竭(LF)发生及预后的预测价值。方法选择34例LF和30例慢性肝炎(CH)患者作为研究对象,采用酶联免疫吸附法(ELISA)检测血清MMP-2表达水平,分析其与谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBil)、凝血酶原时间(PT)的相关性;采用Logistic二元回归分析和受试工作者特征(ROC)曲线方法分析MMP-2对LF发生及预后的预测价值。结果 LF患者血清MMP-2为(1.77±1.06)ng/ml;CH患者为(0.34±0.32)ng/ml;健康对照组为(0.56±0.27)ng/ml。LF患者明显高于CH、健康对照组(t=7.476、5.969,P=0.000、0.000);血清MMP-2与ALT无相关性(rs=-0.179,P=0.156),与AST、TBil呈正相关(rs=0.358、0.700,P=0.004、0.000)、与PT亦呈正相关(r=0.710,P=0.000);MMP-2预测LF发生ROC下面积为0.960;死亡LF患者血清MMP-2为(2.52±1.10)ng/ml,好转者为(1.10±0.35)ng/ml,两者差异有统计学意义(t=4.921,P=0.000);死亡者TBil为353.3(37.8,693.1)μmol/L,好转者为95.1(54.2,600)μmol/L,两者差异有统计学意义(Hc=39.78,P=0.000)。MMP-2预测LF死亡发生的ROC下面积为0.896(z=7.071,P=0.000);TBil预测LF死亡发生的ROC下面积为0.736(z=2.511,P=0.0121);两者相比,差异无统计学意义(z=1.462,P=0.1437)。以MMP-2、TBil作为参数拟合预测LF短期预后的Logistic二元回归方程,拟合优度高(χ2=11.636,P=0.113),准确性达到94.1%。结论 MMP-2与肝脏炎症损伤有一定关系,可作为预测肝衰竭发生的指标之一,MMP-2联合TBil对LF患者短期预后有较好的预测功能。

Objective To explore the predictive value of serum matrix metalloproteases （ MMP）-2 for the happening and the prognosis of liver failure（LF）. Methods 34 patients with LF and 30 patients with CH were enrolled in the study. MMP-2 was detected by ELISA. The relationship between MMP-2 and ALT, AST, TBil, PT were analyzed. The logistic bi- nary regression equation and the area of Receiver Operating Characteristic （ROC） curve were used to analyze the predictive value of MMP-2 for the happening and the prognosis of LF. Results Serum MMP-2 in patients with LF I （ 1.77 ±1.06） ng/ml ] was higher than that in patients with CH [ （0.34 ± 0.32 ） ng/ml ] and in healthy controls [ （0.56 ± 0.27 ） ng/ml ] （t = 7. 476,5. 969;P = 0. 000,0. 000）. No correlation was found between MMP-2 and ALT （r2 = -0. 179, P = 0. 156）, there was positive correlation between MMP-2 and AST, TBil （ r2= 0. 358,0. 700, P = 0. 004,0. 000）. MMP-2 was positively correlated with PT （r = 0.710, P = 0. 000 ）. The area under the ROC cure of MMP-2 predicting the happen- ing of LF was 0. 960. The serum MMP-2 in the deaths [ （2.52 ＋ 1.10） ng/ml ] was higher than that in the survivals [ （ 1.10 ± 0.35） ng/ml ] （ t = 4. 921,P = 0.000）. The serum TBil in the deaths 353.3 （ 37.8,693.1 ） μmol/L was higher than in the survivals 95.1 （54.2,600） Ixmol/L （ Hc = 39.78, P = 0. 000）. The area under the ROC curve of MMP-2, TBil predicting the death in patients with LF was 0. 896,0. 736 respectively. No difference was found in the two markers（z = 1. 462,P = 0. 1437）. If taking MMP-2, TBil as parameter predicting the prognosis of LF, the logistic binary regression e- quation had high goodness-of-fitting（~2 = 11. 636,P = 0.113）, the accuracy was 94.1%. Conclusion MMP-2 had certain correlation with inflammation of liver. MMP-2 could be seen a marker predicting the happening of LF. MMP-2 combined with TBil had good predictive capability for predicting the short-term prognosis in patients with LF.