MELD评分及血清DcR3、RIPK3、hBD-1水平对慢加急性肝衰竭患者预后的预测价值

Predictive value of MELD scores and serum levels of DcR3,RIPK3 and hBD-1 on prognosis of patients with chronic-on-acute liver failure

目的探讨终末期肝病模型(MELD)评分及血清诱骗受体3(DcR3)、受体相互作用蛋白激酶3(RIPK3)、人β-防御素-1(hBD-1)水平对慢加急性肝衰竭(ACLF)患者预后的预测价值。方法选择2017年6月至2020年1月在该院接受治疗的115例ACLF患者(观察组)、80例慢性乙型肝炎患者(肝炎组)及同期80例体检健康志愿者(对照组)作为研究对象。检测并比较3组血清DcR3、RIPK3、hBD-1水平。收集ACLF患者临床资料,根据入院30 d时ACLF患者生存情况将其分为死亡组(34例)和存活组(81例),比较两组的临床资料、MELD评分及血清DcR3、RIPK3、hBD-1水平。采用多因素Logistic回归模型分析影响ACLF患者预后的危险因素,利用受试者工作特征(ROC)曲线分析MELD评分、DcR3、RIPK3、hBD-1对ACLF患者预后的预测价值。结果观察组血清DcR3、RIPK3、hBD-1水平高于肝炎组、对照组,肝炎组血清DcR3、RIPK3、hBD-1水平高于对照组,差异均有统计学意义(P<0.05)。死亡组国际标准化比值、MELD评分及血清总胆红素、DcR3、RIPK3、hBD-1水平高于存活组,差异均有统计学意义(P<0.05)。多因素Logistic回归模型分析结果显示,高MELD评分及高水平DcR3、RIPK3、hBD-1是ACLF患者死亡的独立危险因素(OR>1,P<0.05)。ROC曲线分析结果显示,MELD评分、DcR3、RIPK3、hBD-1单独和联合检测预测ACLF患者死亡的曲线下面积分别为0.759、0.818、0.796、0.775、0.910。结论高MELD评分及高水平DcR3、RIPK3、hBD-1是ACLF患者死亡的独立危险因素,可作为评估ACLF患者短期预后的参考指标。

Objective To investigate the predictive value of model for end-stage liver disease(MELD)score and serum levels of decoy receptor 3(DcR3),receptor-interacting protein kinase 3(RIPK3)and humanβ-defensin-1(hBD-1)on prognosis of patients with acute-on-chronic liver failure(ACLF).Methods From June 2017 to January 2020,115 patients with ACLF(the observation group)and 80 patients with chronic hepatitis B(the hepatitis group)who were treated in this hospital and 80 physical examination healthy volunteers(the control group)were selected as the research objects.The serum levels of DcR3,RIPK3 and hBD-1 were detected and compared among the three groups.The clinical data of ACLF patients were collected and divided into the death group(34 cases)and the survival group(81 cases)according to the survival of ACLF patients at 30 days after admission.The clinical data,MELD score and serum levels of DcR3,RIPK3 and hBD-1 were compared between the two groups.Multivariate Logistic regression model was used to analyze the risk factors affecting the prognosis of ACLF patients,and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of MELD score,DcR3,RIPK3 and hBD-1 on the prognosis of patients with ACLF.Results The serum levels of DcR3,RIPK3 and hBD-1 in the observation group were higher than those in the hepatitis group and the control group,and the serum levels of DcR3,RIPK3 and hBD-1 in the hepatitis group were higher than those in the control group,and the differences were statistically significant(P<0.05).The international normalized ratio,MELD score and serum levels of total bilirubin,DcR3,RIPK3 and hBD-1 in the death group were higher than those in the survival group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression model analysis showed that high MELD score and high levels of DcR3,RIPK3 and hBD-1 were independent risk factors for death in ACLF patients(OR>1,P<0.05).The ROC curve analysis results showed that the areas under the curve of MELD score,DcR3,RIPK3,hBD-1 alone and in combined detection to predict the death of ACLF patients were 0.759,0.818,0.796,0.775 and 0.910,respectively.Conclusion High MELD score and high levels of DcR3,RIPK3 and hBD-1 are independent risk factors for death in patients with ACLF,and they can be used as reference indicators to evaluate the short-term prognosis of patients with ACLF.