甲胎蛋白在慢加急性肝衰竭临床预后分型中的应用价值

Alpha fetoprotein in clinical prognostic classification of acute-on-chronic liver failure

目的探讨甲胎蛋白(AFP)在慢加急性肝衰竭(ACLF)临床预后分型中的应用价值。方法采用多中心回顾性队列研究,纳入有基线AFP结果的ACLF患者,将患者的预后分为快速进展型、快速恢复型、缓慢进展型、缓慢恢复型、缓慢持续型,比较各预后分型之间基线AFP及入院7 d内AFP动态变化趋势,分析AFP对ACLF患者临床预后的影响。结果共入组312例ACLF患者,临床预后分别为快速进展型84例(26.9%),快速恢复型90例(28.8%),缓慢进展型44例(14.1%),缓慢恢复型65例(20.8%),缓慢持续型29例(9.3%)。基线AFP水平在快速恢复型患者中最高,为53.7 ng/ml(12.1~193.3 ng/ml),在缓慢持续型患者中最低,为7.5 ng/ml(2.5~50.7 ng/ml);与其他预后分型相比,AFP≥200 ng/ml在快速恢复型患者中的比例最高(24.4%),而基线AFP<20 ng/ml在缓慢持续型患者中的比例最高(65.5%),20 ng/ml≤AFP<200 ng/ml在各分型之间比例分布差异无统计学意义。在131例有入院后7 d内AFP动态变化的患者中,快速进展型与缓慢持续型患者AFP持续<20 ng/ml的比例较高,分别为46.9%与58.3%,而在快速恢复型患者中AFP动态升高的比例最高(45.9%),显著高于其他各型患者(P<0.05)。经校正MELD评分的多因素分析显示,基线AFP≥200 ng/ml、入院7 d内AFP动态升高的患者快速恢复率增加。结论AFP基线水平及入院7 d内变化趋势对ACLF临床动态预后有一定预测价值,尤其是对患者快速恢复的预测。

Objective To investigate the value of alpha fetoprotein(AFP)in differentiating clinical outcomes of acute-on-chronic liver failure(ACLF).Methods A multicenter retrospective cohort study was conducted to include ACLF patients with baseline AFP results,and the outcomes of patients were classified as rapid progression,slow progression,rapid recovery,slow recovery,slow persistence,and the trends of AFP dynamic changes at baseline and within 7 days of admission among these prognostic categories were compared to analyze the effects of AFP on clinical outcomes of ACLF patients.Results A total of 312 ACLF patients were enrolled,and the clinical outcomes were 84(26.9%)rapid progression,90(28.8%)rapid recovery,44(14.1%)slow progression,65(20.8%)slow recovery,and 29(9.3%)slow persistence.Baseline AFP levels were highest at 53.7 ng/ml(12.1~193.3 ng/ml)in the rapid recovery type patients and lowest at 7.5 ng/ml(2.5~50.7 ng/ml)in the slow persistence type patients.Compared with the other prognostic subtypes,the highest proportion(24.4%)of AFP≥200 ng/ml was found in the rapid recovery type patients,while the highest proportion(65.5%)of baseline AFP<20 ng/ml was found in the slow persistence type patients,and the distribution of proportions with 20 ng/ml≤AFP<200 ng/ml did not differ significantly in the subtypes.Among 131 patients who had AFP dynamic changes within 7 days of admission,the proportion of patients with AFP persistent<20 ng/ml were higher in rapidly progressive type(46.9%)and slowly persistent type(58.3%),whereas the proportion with AFP dynamic elevation was highest in rapidly recovering patients(45.9%)and significantly higher than that in patients with all other types(P<0.05).Multivariate analysis adjusted for MELD score showed an increased rate of rapid recovery in patients with baseline AFP≥200 ng/ml and dynamic elevation of AFP within 7 days of admission.Conclusion The baseline level of AFP and the trend of its change within 7 days of admission have some predictive value for the clinical dynamic prognosis of ACLF,especially for the rapid recovery of patients.