HBV相关慢加急性肝衰竭患者血清角蛋白18水平及其与患者预后的关系探讨

Prognostic efficacy of serum keratin 18 in patients with hepatitis B virus-related acute on chronic liver failure

目的探讨乙型肝炎病毒相关性慢加急性肝衰竭(HBV-ACLF)患者血清角蛋白18(K-18)水平变化及其对患者预后的预测价值。方法 2015年1月～2017年1月我院收治的HBV-ACLF患者100例,另选择性别和年龄相匹配的慢性乙型肝炎(CHB)患者30例和健康人30例。采用酶联免疫吸附试验法检测血清K18(M30和M65)水平。随访3 m。应用受试者工作特征曲线(ROC)分析M30/M65比值和终末期肝病模型(MELD)预测患者预后的效能。结果 ACLF患者血清M30、M65水平和M30/M65比值分别为(1.0±0.1) lg U/L、(3.4±0.3) lg U/L和(0.3±0.1),与CHB患者【分别为(2.1±0.1) lg U/L、(3.3±0.2) lg U/L和(0.6±0.0)】或者健康人【分别为(2.1±0.1) lg U/L、(2.1±0.1) lg U/L和(1.0±0.2)】比,有显著性统计学差异(P<0.05);68例生存患者MELD评分为(18.2±.0),显著低于32例死亡患者的【(26.1±3.3),P<0.05】,血清M65水平为(2.9±0.2) lg U/L,显著低于死亡患者的【(4.1±0.5) lg U/L,P<0.05】,M30/M65比值为(0.4±0.1),显著高于死亡患者的【(0.2±0.1),P<0.05】;MELD评分预测ACLF患者死亡的截断点为23.21,其AUC为0.650,预测的灵敏度、特异度和正确性分别为85.5%、65.0%和72.0%,而M30/M65比值预测ACLF患者死亡的截断点为0.30,其AUC为0.875,预测的灵敏度、特异度和正确性分别为94.5%、85.0%和85.0%,显著优于MELD评分(P<0.05)。结论 K18(M30和M65)与肝脏疾病的严重程度有关。早期检测血清M30和M65水平可能有助于对HBV-ACLF患者预后的判断。

Objective To investigate the prognostic efficacy of serum keratin 18 in patients with hepatitis B virus-related acute on chronic liver failure(HBV-ACLF). Methods One hundred patients with HBV-ACLF,30 with chronic hepatitis B and 30 healthy persons were recruited in our hospital between January 2015 and January 2017,and serum K18(M30 and M65) levels were measured by enzyme-linked immunosorbent assay. All patients were followed-up for 3 months. The prognostic efficacy of M30/M65 ratio and the end stage liver disease model(MELD)were assessed by AUC. Results Serum M30,M65 and M30/M65 ratio in patients with ACLF at presentation were(1.0±0.1) lg U/L,(3.4±0.3) lg U/L and(0.3±0.1),significantly different as compared to【(2.1±0.1) lg U/L,(3.3±0.2)lg U/L and(0.6±0.0),respectively,P<0.05】in patients with CHB or 【(2.1±0.1) lg U/L,(2.1±0.1) lg U/L and(1.0±0.2),respectively,P <0.05】 in control persons;MELD score in 68 survivals was(18.2 ±.0),significantly lower than【(26.1±3.3),P<0.05】in 32 dead,serum M65 level was [(2.9±0.2) lg U/L,much lower than [(4.1±0.5) lg U/L,P<0.05] in the dead,and M30/M65 ratio was(0.4±0.1),significantly higher than 【(0.2±0.1),P<0.05】 in the dead group;the cut-off-value of MELD in forecasting the prognosis of patients with ACLF was 23.21,and its AUC was0.650,with the sencitivity(Se) of 85.5%,specificity(Sp) of 65.0% and accuracy(Ac) of 72.0%,while the cut-off-value of M30/M65 ratio was 0.30,and its AUC was0.875,with the Se of 94.5%,Sp of 85.0% and Ac of85.0%,much superior to MELD score(P <0.05).Conclusion Serum K18(M30 and M65) level is related to the severity of liver diseases,and early detection of serum M30/M65 might be helpful in predicting the prognosis of patients with HBV-ACLF.