HBV-ACLF病情转归与血清内源性糖皮质激素水平的关系

The relationship between the prognosis of HBV-ACLF and the level of serum endogenous glucocorticoids

目的探究乙肝肝衰竭患者病情转归与血清内源性糖皮质激素水平的关系。方法选择乙肝病毒相关慢加急性肝衰竭(HBV-ACLF)患者及慢性乙肝患者作为研究对象,根据病情将HBV-ACLF患者分为早期、中期、晚期3组。测定患者血清皮质醇及生化指标水平,随访比较不同病情转归肝衰竭患者血清皮质醇水平。结果皮质醇、凝血酶原活动度(PTA)等指标水平随肝衰竭程度加重而下降;丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBil)、血肌酐(Cr)、国际标准化比值(INR)、终末期肝病模型(MELD)评分则随肝衰竭程度加重而上升;外周血皮质醇水平与ALT、AST、TBil、MELD评分呈负相关,与PTA呈正相关;120例肝衰竭患者随访1个月时,存活78例,死亡42例,存活组各时间点皮质醇水平均显著高于死亡组(P <0.05)。结论 HBV-ACLF肝衰竭患者血皮质醇水平与患者肝功能、预后相关,其水平可作为预测患者病情程度和预后的指标。

Objective To explore the relationship between the prognosis of patients with hepatitis B failure and the level of serum endogenous glucocorticoids.Methods The patients with Hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF)were selected as the research subjects.According to their conditions,the patients with HBV-ACLF were divided into three groups,i.e.,early group,middle group and late group.Serum cortisol and biochemical indexes were measured,and serum cortisol levels in patients with liver failure were compared after follow-up.Results The levels of cortisol and prothrombin activity(PTA)decreased with the severity of liver failure,while the levels of alanine transaminase(ALT),aspartate transaminase(AST),total bilirubin(TBil),serum creatinine(Cr),international normalized ratio(INR),and the model for end-stage liver disease(MELD)increased with the severity of liver failure.Alcohol levels were negatively correlated with ALT,AST,TBil and MELD scores,and positively correlated with PTA.After a follow-up of 120 patients with liver failure for one month,78 survived and 42 died.Cortisol levels in the survival group were significantly higher than those in the death group at all time-points(P<0.05).Conclusion The level of serum cortisol in patients with HBV-ACLF liver failure is correlated with their liver function and prognosis.The level of cortisol can be used as an index to predict the severity and prognosis of patients with HBV-ACLF.