肠脂肪酸结合蛋白与肝硬化患者细菌感染和不良预后的相关性研究

Correlation between intestinal fatty acid-binding protein and bacterial infection as well as poor prognosis in patients with liver cirrhosis

目的 评估肠脂肪酸结合蛋白(I-FABP)对肝硬化患者预后预测的价值。方法 采用前瞻性研究方法,连续收集某院2020年9月—2022年5月住院治疗的肝硬化患者,根据Child-Pugh评分对患者进行分层,随访时间12个月,以评估其生存及细菌感染情况。采用酶联免疫吸附试验(ELISA)法测定患者入院血清I-FABP水平。两变量间相关性应用Spearman相关分析。多因素Cox回归模型预测随访期间细菌感染和死亡的危险因素。时间依赖性ROC曲线评估I-FABP对肝硬化相关死亡的预测性能。结果 共纳入131例肝硬化患者,随访期间有45例患者因细菌感染或感染发展住院治疗。感染住院中位时间为115(42, 251)d,平均住院时间15 d。最常见的感染是自发性细菌性腹膜炎(SBP),占20.6%(27例)。I-FABP与血清IL-6(r=0.270,P<0.001)和MELD评分(r=0.364,P<0.001)相关,并随疾病严重程度增加而升高(Child-Pugh A级=1.18μg/L,Child-Pugh B级=1.51μg/L和C级=2.29μg/L)。随访期间有45例(34.4%)患者因细菌感染累积住院71次,27例合并SBP患者的I-FABP中位数高于未合并者(2.26 VS 1.25,P=0.001)。此外,观察期累计死亡患者29例,3、6、9、12个月的病死率分别为4.6%、13.7%、19.8%、22.1%。多因素Cox回归分析显示,基线I-FABP可以预测SBP和1年生存率,且I-FABP四分位数显示出良好的预后区分能力。时间依赖性AUC显示I-FABP在不同时间点对肝相关死亡的预测能力与MELD评分相近,上述两种参数的联合模型显示出较高的预测价值。结论 I-FABP能较好地预测肝硬化相关SBP发生及长期生存方面的预后。

Objective To evaluate the predictive value of intestinal fatty acid-binding protein(I-FABP) in the prognosis of patients with liver cirrhosis. Methods A prospective study method was used to continuously collect patients with liver cirrhosis, who were hospitalized in a hospital from September 2020 to May 2022. Patients were stratified according to the Child-Pugh score, and followed up 12 months to evaluate their survival and bacterial infection. Serum I-FABP level of patients at admission was measured by enzyme-linked immunosorbent assary(ELISA). The correlation between two variables was analyzed by Spearman correlation analysis. Risk factors for bacterial infection and death during follow-up was predicted with multivariate Cox regression model. Predictive efficacy of I-FABP for cirrhosis-related death was evaluated with time-dependent receiver operating characteristic(ROC) curve. Results A total of 131 patients with liver cirrhosis were included. During the follow-up period, 45 patients were hospitalized due to bacterial infection or infection progress. The median length of hospital stay due to infection was 115(42, 251) days, and the average length of hospital stay was 15 days. The most common infection is spontaneous bacterial peritonitis(SBP), accounting for 20.6%(n=27). I-FABP was correlated with serum IL-6(r=0.270, P<0.001) and MELD score(r=0.364, P<0.001), and increased with the severity of the disease(Child-Pugh A=1.18 μg/L, Child-Pugh B=1.51 μg/L and C=2.29 μg/L). During the follow-up period, 45 patients(34.4%) were hospitalized for 71 times due to bacterial infection. The median I-FABP of 27 patients with SBP was higher than those without SBP(2.26 vs 1.25, P=0.001). In addition, 29 patients died during the observation period. The mortality at 3 months, 6 months, 9 months and 12 months were 4.6%, 13.7%, 19.8% and 22.1%,respectively. Multivariate Cox regression analysis showed that baseline I-FABP could predict SBP and 1-year survi-val rate, and the I-FABP quartile showed good prognostic differentiation. Time-dependent AUC showed no difference in predicting mortality of liver-related death between I-FABP and MELD score. The combined model of the two parameters showed a high predictive value. Conclusion I-FABP can predict the occurrence of cirrhosis-associated SBP and the long-term survival in patients with liver cirrhosis.