血清sST2和IL-33在乙肝相关慢加急性肝衰竭患者中的测定及其临床价值的探讨

The Determination of Serum sST2 and IL-33 in Patients with Hepatitis B Virus-related Acute-on-chronic Liver Failure and Its Clinical Value

目的探究血清可溶性致瘤抑制蛋白2(sST2)和IL-33在乙肝病毒相关慢加急性肝衰竭(HBV-ACLF)患者中的水平及其与疾病严重程度、结局的关系,寻找能够监测疾病发生发展的潜在生物学标志物。方法收集2017年9月至2021年8月我院收治的HBV-ACLF组患者63例,乙肝病毒相关肝硬化组(HBV-LC)患者22例,另纳入健康人群30例作为健康对照(HC)组。ELISA法检测血清sST2和IL-33的水平,并利用统计学方法分析检测结果与患者疾病发展及结局的关系。结果HBV-ACLF组患者血清sST2和IL-33水平均较HC组和HBV-LC组明显升高,3组间差异具有统计学意义(P<0.001)。好转组sST2和IL-33均低于死亡组,且差异具有统计学意义(P<0.01)。在经过住院治疗后,除了sST2死亡组外,其他3组均出现了下降的趋势,且差异具有统计学意义(P<0.01)。根据单因素和多因素ROC曲线分析结果,我们发现sST2联合终末期肝病模型(MELD)评分的最佳截断值为0.60,ROC曲线下面积(AUC)为0.906,优于单个指标,提示sST2和MELD评分联合检测可以更好地监测HBV-ACLF患者的病程发展及结局,为临床提供更佳的预测模型。结论本研究通过测定血清sST2和IL-33,分析其与HBV-ACLF患者疾病发生发展的关系,发现sST2可能作为新型潜在生物标志物联合MELD评分辅助临床监测患者病情进程及结局。

Objective To investigate levels of serum soluble suppression of tumorigenicity 2(sST2)and IL-33 in hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)patients and their relationships with disease severity and patient outcomes.To identify potential biological markers that can monitor the occurrence and progression of diseases.Methods A total of 63 patients in HBV-ACLF group,22 patients in hepatitis B virus-related liver cirrhosis(HBV-LC)group and 30 healthy people in the healthy control(HC)group were selected in our hospital from September,2017 to August,2021.Levels of serum sST2 and IL-33 were measured by ELISA and statistically analyzed for their relationships with the disease development and outcomes of patients.Results Levels of serum sST2 and IL-33 in HBV-ACLF group were significantly higher than those in HC group and HBV-LC group,and the difference was statistically significant among the three groups(P<0.001).The average levels of sST2 and IL-33 in the survival group of HBV-ACLF patients were lower than those in the death group(P<0.01).After hospitalization,the other three groups showed a downward trend except for the sST2 death group(P<0.01).According to the results of univariate and multivariate ROC curve analysis,we found that the optimal cut-off value of sST2 combined with end-stage liver disease model(MELD)score was 0.60,and the area under ROC curve(AUC)was 0.906,which was better than that of the single index.Also,it suggested that the combined detection of sST2 and MELD scores could better monitor the courses and outcomes of HBV-ACLF patients,and provided a better predictive model for clinical practice.Conclusion In this study,serum sST2 and IL-33 were measured to analyze their relationships with the disease development of HBV-ACLF patients,and it was found that sST2 may be used as a novel potential biomarker combined with MELD score to assist clinical monitoring of patients’disease progress and outcomes.