HBV相关慢加急(亚急)性肝衰竭患者血清AFP、CA199临床意义的研究

Clinical Significance of Serum AFP and CA199 in Patients with HBV-related Slow-acceleration(Sub-acute) Liver Failure

目的探究发病1周内血清甲胎蛋白(AFP)及CA199水平与HBV相关慢加急(亚急)性肝衰竭(HBV-ACLF)患者病情及预后的关系。方法回顾性分析2013年1月～2017年12月我院收治的62例HBV相关慢加急(亚急)性肝衰竭患者的临床资料,记录患者入院1周内AFP、CA199、TBiL、PTA及ALB临床数据,比较AFP及CA199水平阳性与阴性对应肝功情况,进一步分别将AFP水平划分为<100 ng/ml、100～200 ng/ml、>200 ng/ml三个水平梯度及CA199水平划分为<120 U/ml、120～200U/ml、>200 U/ml三个水平梯度,比较对应肝生化指标、存活及死亡率情况。分析AFP及CA199水平与终末期肝病模型评分(Meld评分)相关性,将Meld评分划分为<20分、20～24分、25～29分、≥30分等四个梯度,比较AFP及CA199水平,结合存活组与死亡组AFP及CA199水平,探究AFP及CA199水平对患者预后的预测价值。结果 (1)CA199水平阳性患者TBiL水平高于阴性患者、PTA水平低于阴性患者,差异有统计学意义(P<0.05);AFP水平阳性与阴性患者肝生化指标比较,差异无统计意义(P>0.05);(2)AFP>200 ng/ml时TBiL及PTA水平最高,AFP<100 ng/ml时TBiL及PTA水平最低,AFP不同梯度组下各肝生化指标比较,差异均无统计学意义(P>0.05);CA199>200 U/ml时TBiL水平最高,PTA水平最低,TBiL水平随CA199梯度增加而升高,PTA水平随之下降,CA199不同梯度下TBiL及PTA水平比较,差异均有统计学差异(P<0.05);(3)在AFP<100 ng/ml梯度组患者死亡率最高,达到28.57%;CA199>200 U/ml梯度组死亡率最高,达到33.33%;(4)Meld评分≥30分,死亡率最高,AFP水平最低,AFP水平在不同Meld评分梯度下比较,差异无统计学意义(P>0.05);(5)Meld评分<20分时,死亡率最低,CA199水平最低,Meld评分在20～29分时CA199水平最高,CA199水平在不同Meld评分梯度下比较,差异有统计学意义(P<0.05);(6)AFP及CA199水平在存活组与死亡组之间比较,差异无统计学意义(P>0.05)。结论 (1)在一定程度内AFP随着肝损害加重而升高,当病情超过一定程度后,AFP呈现下降趋势,预后较差;一定范围内AFP水平升高,提示预后良好;(2)CA199水平与肝损害程度相一致,CA199水平越高,肝损害程度越重,当病情严重时CA199呈现下降趋势,预后较差;(3)在HBV-ACLF中联合检测AFP及CA199升高水平对于评估病情及预后有一定参考意义。

Objective To investigate the relationship between serum alpha-fetoprotein (AFP) and CA199 levels and the severity and prognosis of patients with HBV-related slow-acceleration (sub-acute) liver failure (HBV-ACLF) within 1 week of onset.Methods The clinical data of 62 patients with HBV-related slow-acceleration (sub-acute) liver failure admitted to our hospital from January 2013 to December 2017 were retrospectively analyzed. AFP, CA199, TBiL, PTA and patients were recorded within 1 week after admission. ALB clinical data, comparing AFP and CA199 levels positive and negative corresponding liver function, further divided AFP levels into <100 ng/ml, 100~200 ng/ml,>200 ng/ml three horizontal gradient and CA199 level division Three horizontal gradients of <120 U/ml, 120-200 U/ml, and >200 U/ml were compared to compare liver biochemical indicators, survival and mortality. The correlation between AFP and CA199 levels and the end-stage liver disease model score (Meld score) was analyzed. The Meld score was divided into four gradients of <20 points, 20-24 points, 25~29 points,≥30 points, and the AFP and CA199 levels were compared. In combination with the AFP and CA199 levels in the survival and death groups, the predictive value of AFP and CA199 levels in the prognosis of patients was explored. Results ①The level of TBiL in patients with positive CA199 level was higher than that in negative patients, and the level of PTA was lower than that in negative patients,the difference was not statistically significant (P>0.05);②The levels of TBiL and PTA were the highest at AFP>200 ng/ml, the lowest at the AFP<100 ng/ml, and the lowest at the AFP level,the difference was not statistically significant (P>0.05);CA199 The highest level of TBiL was found at >200 U/ml, and the level of PTAL was the lowest. The level of TBiL increased with the increase of CA199 gradient, and the level of PTA decreased. The difference of TBIL and PTA levels under different gradients of CA199 was statistically significant (P<0.05).③In the AFP<100 ng/ml gradient group, the mortality rate was the highest, reaching 28.57%;the CA199>200 U/ml gradient group had the highest mortality rate, reaching 33.33%;④Meld score ≥ 30, mortality was the highest, AFP level was the lowest, AFP level was different under different Meld scores, the difference was not statistically significant (P>0.05);⑤When the Meld score was <20, the mortality rate was the lowest, the CA199 level was the lowest, the Meld score was the highest at 20-29, and the CA199 level was compared under the different Meld scores,the difference was statistically significant (P<0.05);⑥There was no significant difference in the levels of AFP and CA199 between the survival group and the death group (P>0.05). Conclusion ①AFP increased with the increase of liver damage to a certain extent. When the disease exceeded a certain level, AFP showed a downward trend and the prognosis was poor. AFP level increased within a certain range, indicating a good prognosis;②The level of CA199 was consistent with the degree of liver damage. The higher the level of CA199, the more severe the degree of liver damage. When the condition was severe, CA199 showed a downward trend and the prognosis was poor.③Combined detection of elevated levels of AFP and CA199 in HBV-ACLF has certain reference significance for assessing the condition and prognosis.