Caspase-1、OPN在慢加急性乙型肝炎肝衰竭患者血清中的表达及其临床意义

Expression of Caspase-1 and OPN in Serum of Patients with HBV-Related Acute-on-Chronic Liver Failure and its Clinical Significance

目的:探讨半胱氨酸蛋白酶-1 (Caspase-1)、骨桥蛋白(OPN)在慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者血清中的表达及其临床意义。方法:选择2020年6月至2022年6月中国人民解放军联勤保障部队第九七〇医院收治的86例HBV-ACLF患者(HBV-ACLF组);另选取同时段接诊的58例慢性HBV感染患者(CHB组);收集同时间段60例体检的健康志愿者(对照组)。检测所有受试者血清Caspase-1、OPN、肝功能指标水平,探讨HBV-ACLF患者血清Caspase-1、OPN水平与肝功能指标的相关性,单因素分析及Logistic多元逐步回归分析影响HBV-ACLF患者预后的危险因素。结果:三组血清Caspase-1、OPN、肝功能指标水平比较差异有统计学意义(P<0.01)。HBV-ACLF组、CHB组血清Caspase-1、OPN、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)水平高于对照组(P<0.05),白蛋白(Alb)、胆碱酯酶(CHE)水平低于对照组(P<0.05),HBV-ACLF组血清Caspase-1、OPN、ALT、AST、TBIL水平高于CHB组(P<0.05),Alb、CHE水平低于CHB组(P<0.05)。Pearson相关分析显示,HBV-ACLF患者血清Caspase-1、OPN水平均与ALT、AST、TBIL呈正相关(P<0.05),与Alb、CHE呈负相关(P<0.05)。单因素分析显示,HBV-ACLF患者预后与肝硬化、肝性脑病、腹膜炎发生率、终末期肝病评分模型(MELD)评分、白细胞计数(WBC)、血小板计数(PLT)、肌酐(Cr)、国际标准化比值(INR)、TBIL、HBV-DNA载量(HBV-DNA)、Caspase-1、OPN有关(P<0.05);而与年龄、性别、血红蛋白(HGB)、BUN、ALT、AST、CHE、Alb无关(P>0.05)。Logistic多元逐步回归分析模型结果显示,HBV-DNA、MELD评分、Caspase-1、OPN是影响HBV-ACLF患者预后的危险因素(P<0.05)。结论:HBV-ACLF患者血清Caspase-1、OPN水平呈异常高表达,且Caspase-1、OPN高表达水平与肝功能恶化和不良临床结局有关,可为HBV-ACLF患者病情进展及预后评估提供依据。

Objective:To investigate the expression of Cysteine proteinase-1(Caspase-1)and osteopontin(OPN)in serum of patients with HBV-related acute-on-chronic liver failure(HBV-ACLF)and its clinical significance.Methods:Selected 86 HBV-ACLF patients(HBV-ACLF group)admitted to the 970th Hospital of Joint Support Force of the Chinese People's Liberation Army from June 2020 to June 2022.In addition,58 patients with chronic HBV infection(CHB group)were selected at the same time.60 healthy volunteers(control group)were collected for physical examination at the same time.Detected the levels of serum Caspase-1,OPN and liver function indicators of all subjects,explored the correlation between serum Caspase-1,OPN levels and liver function indicators in patients with HBV-ACLF,and analyzed the risk factors affecting the prognosis of patients with HBV ACLF by univariate analysis and Logistic multiple stepwise regression analysis.Results:There were significant differences in serum Caspase-1,OPN and liver function indexes among the three groups(P<0.01).The levels of serum Caspase-1,OPN,Alanine transaminase(ALT),Aspartate transaminase(AST)and total bilirubin(TBIL)in HBV-ACLF group and CHB group were higher than those in control group(P<0.05),and the levels of Albumin(Alb)and cholinesterase(CHE)were lower than those in control group(P<0.05).The levels of serum Caspase-1,OPN,ALT,AST and TBIL in HBV-ACLF group were higher than those in CHB group(P<0.05),and the levels of Alb and CHE were lower than those in CHB group(P<0.05).Pearson correlation analysis showed that serum Caspase-1 and OPN levels in HBV-ACLF patients were positively correlated with ALT,AST and TBIL(P<0.05),and negatively correlated with Ab and CHE(P<0.05).Univariate analysis showed that the prognosis of HBV-ACLF patients was related to incidence rate of liver cirrhosis,hepatic encephalopathy,peritonitis,MELD score,white blood cell count(WBC),platelet count(PLT),creatinine(Cr),international normalized ratio(INR),TBIL,HBV-DNA load(HBV-DNA),Caspase-1,OPN(P<0.05),whlie was not related to age,sex,hemoglobin(HGB),BUN,ALT,AST,CHE,Alb(P>0.05).Logistic multiple stepwise regression analysis model showed that HBV-DNA,MELD score,Caspase-1 and OPN were risk factors affecting the prognosis of patients with HBV ACLF(P<0.05).Conclusion:The levels of serum Caspase-1 and OPN in patients with HBV-ACLF are abnormally high,and the high expression levels of Caspase-1 and OPN are related to the deterioration of liver function and adverse clinical outcomes,which can provide a basis for the progression and prognosis of patients with HBV-ACLF.