乙型肝炎相关慢加急性肝衰竭患者血清碱性磷酸酶的变化及意义

Changes of serum alkaline phosphatase in patients with HBV-related acute-on-chronic liver failure and its significance

目的探讨乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者血清碱性磷酸酶(ALP)的变化及意义。方法收集2015年1月至2018年12月在苏州大学附属第一医院感染病科住院的92例HBV-ACLF患者,40例慢性乙型肝炎(CHB)患者及34名健康对照者,比较3组人群的外周血ALP水平差异。观察HBV-ACLF患者存活组和死亡组入院时和入院后1周ALP水平的动态变化;比较HBV-ACLF患者ALP上升组和ALP下降组存活率的差异;分析HBV-ACLF患者入院后1周ALP的上升值与前白蛋白(PAB)和终末期肝病评分(model for end stage liver disease,MELD)的相关性。结果HBV-ACLF组、CHB组、健康对照组ALP水平分别为(421.37±136.35)、(116.14±38.62)和(104.23±35.19)U/L,3组间差异有统计学意义(F=77.193,P<0.05),HBV-ACLF组ALP水平较CHB组及健康对照组明显升高(q值分别为3.704、4.548,均P<0.05)。HBV-ACLF患者存活组ALP(86.17±19.36)U/L明显高于死亡组(29.46±8.21)U/L,差异有统计学意义(t=4.78,P<0.05)。HBV-ACLF患者ALP上升组存活率73.08%(38/52)高于ALP下降组32.5%(13/40),差异有统计学意义(χ^2=33.48,P<0.05)。HBV-ACLF患者入院后1周MELD评分为(35.63±5.81)分,PAB水平为(73.57±32.69)g/L,入院后1周ALP上升值与MELD评分呈负相关,与PAB呈正相关(r分别为-0.725、0.763,均P<0.05)。结论HBV-ACLF患者外周血ALP持续升高是患者预后良好的标志。

Objective To investigate the changes of serum alkaline phosphatase(ALP)in patients with hepatitis B virus(HBV)-related acute-on-chronic liver failure(HBV-ACLF)and its significance.Methods A total of 92 HBV-ACLF patients hospitalized in our hospital from January 2015 to December 2018 were enrolled in the study,as well as 40 patients with chronic hepatitis B(CHB)and 34 healthy controls.ALP levels in peripheral blood of the 3 groups were compared.Differences of the dynamic changes in ALP levels from admission to 1 week after admission were studied.In HBV-ACLF patients,survival rates between increasing ALP group and decreasing ALP group were compared.The associations of the increase of ALP with pre-albumin level and model for end-stage liver disease(MELD)score were analyzed.Results The ALP levels of HBV-ACLF group,CHB group and control group were(421.37±136.35),(116.14±38.62)and(104.23±35.19)U/L,respectively,and the differences among groups were significant(F=77.193,P<0.05).The ALP level of HBV-ACLF group was significantly higher than that of CHB group and control group(Q=3.704 and 4.548,respectively,P<0.05 for both).In HBV-ACLF patients,the increase of ALP of survival subgroup was significantly higher than that of death subgroup,and the difference was statistically significant[(86.17±19.36)vs(29.46±8.21)U/L,t=4.78,P<0.05].The survival rate of increasing ALP subgroup was higher than that of decreasing ALP subgroup,and the difference was statistically significant(73.08%vs 32.5%,χ^2=33.48,P<0.05).One week after admission,the MELD score of patients with HBV-ACLF was(35.63±5.81),and the pre-albumin level was(73.57±32.69)g/L.The increase of ALP was negatively correlated with MELD score,and positively correlated with pre-albumin level(r=-0.725 and 0.763,respectively,P<0.05 for both).Conclusion The continuous increase of peripheral blood ALP in patients with HBV-ACLF is a predictor of good prognosis.