sCD30在乙肝肝硬化急性失代偿患者中的表达及预后意义

Expression and prognostic significance of sCD30 in acute decompensated patients with hepatitis B cirrhosis

目的探索可溶性CD30(sCD30)在慢性乙型肝炎(CHB)、乙型肝炎(乙肝)肝硬化中的表达及其在乙肝肝硬化急性失代偿(LC-AD)患者中的预后意义。方法选取该院感染科及消化内科2020年6月至2021年1月的88例LC-AD患者作为LC-AD组,选取同期CHB患者29例及健康人群(HC)30例作为CHB组和HC组,检测入院当日sCD30水平,收集临床资料及实验室检查结果,以90 d生存情况为主要观察结局。结果LC-AD组入院当日sCD30水平明显高于CHB组及HC组(P<0.05)。88例LC-AD患者中,16例在住院期间进展为慢加急性肝衰竭,15例90 d内死亡。Child-Pugh C级LC-AD患者sCD30水平高于A、B级,死亡、感染、消化道出血患者高于存活、非感染、非出血患者(P<0.05)。sCD30水平与天门冬氨酸氨基转移酶(AST)、总胆红素、降钙素原、国际标准化比值、Child-Pugh评分、终末期肝病(MELD)评分呈正相关(P<0.05)。多因素Cox比例风险回归分析sCD30是患者90 d死亡率的独立的预后因素(HR=1.150,95%CI:1.001~1.321,P=0.049)。入院时sCD30水平预测患者90 d死亡率受试者工作特征(ROC)曲线下面积为0.768(95%CI:0.644~0.891,P=0.001)。Kaplan-Meier生存分析结果表明:sCD30高水平(≥22.79 ng/mL)患者90 d死亡率[47.8%(11/23)]高于低水平患者[6.2%(4/65)],差异有统计学意义(P<0.05)。结论sCD30水平与疾病严重程度相关,可作为患者90 d死亡率的标志物。

Objective To investigate the significance of soluble CD30(sCD30)expression in chronic hepatitis B and Hepatitis B cirrhosis patients,and its prognostic significance in hepatitis B patients with liver cirrhosis-acute decompensation(LC-AD).Methods A total of 88 hepatitis B patients with LC-AD were selected as the LC-AD group from June 2020 to January 2021 in the Department of Infection and the Department of Gastroenterology.Meanwhile the chronic hepatitis B patients(CHB)and the healthy control people(HC)were selected as control groups at the same time.The sCD30 levels were tested on the day of admission,clinical data and laboratory examination results were collected,and the 90-day survival was used as the primary observed outcome.Results The serum sCD30 levels in the LC-AD group were significantly higher than in the CHB and HC groups(P<0.05).Of the 88 patients with LC-AD,16 patients progressed to acute-on-chronic liver failure during hospitalization,and 15 patients died within 90 days.Child-Pugh C patients had higher serum sCD30 levels than grade A and B,and death,infection,bleeding patients were higher than survival,non-infection,non-bleeding patients(P<0.05).Serum sCD30 level was positively correlated with AST,TBIL,NEU,PCT,INR,Child-Pugh score and MELD score(P<0.05).The results of Cox proportional hazards regression showed that serum sCD30(HR:1.150;95%CI:1.001-1.321;P=0.049)was an independent risk factor for the 90-day mortality in LC-AD group.The area under the receiver operating characteristics(ROC)curve for predicting 90-day mortality was 0.768(95%CI:0.644-0.891;P=0.001).The result of Kaplan-Meier survival analysis showed that the 90-day mortality in the high-risk group(sCD30≥22.79 ng/mL)was higher than those in the low-risk group[47.8%(11/23)vs.6.2%(4/65)],and the difference was statistically significant(P<0.05).Conclusion Serum sCD30 level was correlated with the disease severity,it can be used as a marker of 90-day mortality in patients.