失代偿期乙型肝炎肝硬化患者血清细胞角蛋白18水平变化及临床意义

Changes and clinical significance of serum cytokeratin 18 level in patients with decompensated hepatitis B liver cirrhosis

目的 探究失代偿期乙型肝炎肝硬化患者血清细胞角蛋白18(CK18)水平变化及临床意义。方法 选取2016年2月—2021年3月南通市中医院收治的138例失代偿期乙型肝炎肝硬化患者和90慢性乙型肝炎患者分别记为肝硬化组、乙型肝炎组,另选取80例在本院进行体检的健康志愿者作为对照组。对比三组研究对象临床资料及血清CK18水平。统计失代偿期乙型肝炎肝硬化患者急性肾损伤(AKI)发生情况,并依据是否发生AKI,分为发生组和未发生组,并对比发生组和未发生组患者的临床资料。Logistic多因素回归分析影响失代偿期乙型肝炎肝硬化患者AKI发生的危险因素。制作受试者工作特征曲线(ROC),以曲线下面积(AUC)分析血清CK18水平对失代偿期乙型肝炎肝硬化患者并发AKI的预测价值。结果 三组研究对象性别、年龄及BMI对比,差异无统计学意义(P>0.05)。三组研究对象血清CK18对比,差异具有统计学意义(P<0.05)。肝硬化组和乙型肝炎组血清CK18水平均高于对照组(P<0.05)。肝硬化组血清CK18水平高于乙型肝炎组(P<0.05)。本研究中失代偿期乙型肝炎肝硬化患者AKI的发生率为30.43%。发生组尿蛋白量、白蛋白(Alb)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、白细胞介素-18(IL-18)、血肌酐(sCr)、估算肾小球滤过率(eGFR)、尿素氮(BUN)及血清CK18水平均高于未发生组(P<0.05)。Logistic多因素分析结果显示,Scr、eGFR及血清CK18均为失代偿期乙型肝炎肝硬化患者发生AKI的危险因素(OR=2.768、3.196、3.380,P<0.05)。ROC分析显示,血清CK18水平对失代偿期乙型肝炎肝硬化患者并发AKI进行预测的最佳截断点为112.78 ng/mL,灵敏度、特异度分别为71.43%、81.25%,AUC为0.818。结论 血清CK18在失代偿期乙型肝炎肝硬化患者中表达水平异常较高,且血清CK18水平对失代偿期乙型肝炎肝硬化患者并发AKI进行预测的效能较高,可作为临床对此进行评估的重要参考指标。

ObjectiveTo explore the changes and clinical significance of serum cytokeratin 18(CK18)level in patients with decompensated hepatitis B liver cirrhosis.MethodsPeripheral fasting venous blood samples were collected from138 patients with decompensated hepatitis B cirrhosis(cirrhosis group)and 90 patients with chronic hepatitis B(hepatitis B group)at admission to test the CK18 by ELISA.80 healthy physical examinees(control group)underwent collection of peripheral fasting venous blood samples during examination to test the CK18.Peripheral fasting venous blood samples were collected everyday for 7 days from the 138 patients of the cirrhosis group.Those with their serum sCr levels being elevated>26.5μmol/L during 48h or elevated>1.5 times the baseline value within one week were diagnosed as with AKI.Then the cirrhosis group was divided tinto 2 subgroups:AKI subgroup and non-AKI subgroup.Logistic multivariate regression analysis was used to identify the risk factors affecting the occurrence of AKI in patients with decompensated hepatitis B liver cirrhosis.A receiver operating characteristic curve(ROC)was made,and the area under the curve(AUC)was used to analyze the predictive value of serum CK18 level for the occurrence of AKI.Results There was no statistically significant differences in gender,age and BMI among the three groups(all P>0.05).The serum CK18 levels of the cirrhosis group and hepatitis B group were both significantly higher than that of the control group(both P<0.05).The level of serum CK18 of the cirrhosis group was significantly higher than that of the hepatitis B group(P<0.05).The incidence of AKI of the cirrhosis group was 30.43%.The values of urinary protein content,albumin(Alb),acute physiology and chronic health status scoring system II(APACHE II)score,interleukin-18(IL-18),blood creatinine(sCr),estimated glomerular filtration rate(EGFR),urea nitrogen(BUN)and serum CK18 levels of the AKI subgroup were all significantly higher than those of the non-AKI subgroup(all P<0.05).Logistic multivariate analysis showed that Scr,eGFR and serum CK18 were all risk factors for AKI in patients with decompensated hepatitis B cirrhosis(OR=2.768,3.196,3.380,P<0.05).ROC analysis showed that the best cut-off point of serum CK18 level for predicting AKI in patients with decompensated hepatitis B cirrhosis was 112.78 ng/mL,the sensitivity and specificity were 71.43%and 81.25%respectively,and the AUC was 0.818.ConclusionThe expression level of serum CK18 in patients with decompensated hepatitis B cirrhosis is abnormally higher,and the effectiveness of serum CK18 level in predicting AKI in patients with decompensated hepatitis B cirrhosis is very high.,and it can be used as an important reference index for clinical evaluation.