血清Beclin1水平联合PNI对乙型肝炎病毒相关慢加急性肝衰竭患者预后的预测价值

Prognostic value of serum Beclin1 combined with PNI in assessing prognosis of patients with HBVacute-on-chronic liver failure

目的探讨血清Beclin1水平联合预后营养指数(PNI)对乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者预后的预测价值。方法选择HBV-ACLF患者184例(观察组),经规范治疗临床好转出院,随访90天,其中预后不良65例、预后良好119例,同期选择体检健康的志愿者57例(对照组)。采集两组外周静脉血,检测血清Beclin1、白蛋白以及全血淋巴细胞计数,计算PNI。收集HBV-ACLF患者临床资料,采用多因素Logistic回归模型分析HBV-ACLF患者预后不良的影响因素。采用受试者工作特征(ROC)曲线分析血清Beclin1水平和PNI对HBVACLF患者预后不良的预测效能。结果观察组血清Beclin1水平高于对照组,PNI低于对照组(t/U分别为8.576、-9.785,P均<0.01)。HBV-ACLF患者预后不良者血清Beclin1水平高于预后良好者,PNI低于预后良好者(t/U分别为7.817、-6.491,P均<0.01)。多因素Logistic回归分析显示,乙型肝炎表面抗原定量(OR=1.185,95%CI:1.009~1.391)、Beclin1(OR=1.717,95%CI:1.378~2.139)升高为HBV-ACLF患者预后不良的独立危险因素,甲胎蛋白(OR=0.982,95%CI:0.965~0.998)、PNI(OR=0.771,95%CI:0.693~0.859)升高则为其独立保护因素(P均<0.05)。ROC曲线分析显示,血清Beclin1水平和PNI单独与联合预测HBV-ACLF患者预后不良的曲线下面积分别为0.789、0.790、0.886,血清Beclin1水平联合PNI预测HBV-ACLF患者预后不良的曲线下面积高于二者单独(Z分别为3.744、3.630,P均<0.01)。结论血清Beclin1水平升高、PNI降低与HBV-ACLF患者预后不良密切相关;血清Beclin1水平和PNI对HBV-ACLF患者预后不良均有一定预测价值,二者联合时预测价值更高。

Objective To investigate the value of serum Beclin1(Beclin1)combined with prognostic nutritional index(PNI)in assessing the prognosis of patients with hepatitis B virus-acute-on-chronic liver failure(HBV-ACLF).Methods Totally 184 patients with HBV-ACLF were selected(observation group),and they were discharged from the hospital after standardized treatment,and were followed up for 90 days,with poor prognosis of 65 cases and good prognosis of 119 cases;meanwhile,57 cases of volunteers with physical examination and health were selected in the same period(control group).Peripheral venous blood was collected from both groups,and serum Beclin1,albumin,and whole blood lymphocyte counts were measured to calculate PNI.The clinical data of HBV-ACLF patients were collected,and multifactorial Logistic regression model was used to analyze the factors influencing the prognosis of HBV-ACLF patients.The predictive efficacy of serum Beclin1 level and PNI on poor prognosis of HBV-ACLF patients was analyzed by using receiver operating characteristic(ROC)curve.Results Serum Beclin1 level was higher and PNI was lower in the HBV-ACLF group than in the control group(t/U=8.576,-9.785,both P<0.01).Serum Beclin1 level was higher in the poor prognosis subgroup than in the good prognosis subgroup,and PNI was lower than that in the good prognosis subgroup(t/U=7.817,-6.491,both P<0.01).Multifactorial Logistic regression analysis showed that the elevated hepatitis B surface antigen quantification(OR=1.185,95%CI:1.009 to 1.391)and Beclin1(OR=1.717,95%CI:1.378 to 2.139)were independent risk factors for poor prognosis in HBV-ACLF patients,and the elevated fetoprotein(OR=0.982,95%CI:0.965 to 0.998)and PNI(OR=0.771,95%CI:0.693 to 0.859)were independent protective factors(all P<0.05).ROC curve analysis showed that the area under the curve of serum Beclin1,PNI alone and in combination for assessing poor prognosis in patients with HBV-ACLF was 0.789,0.790,and 0.886,respectively,and the area under the curve of serum Beclin1 combined with PNI in assessing poor prognosis in patients with HBV-ACLF was higher than that of either alone(Z=3.744,3.630,both P<0.01).Conclusion Elevated serum Beclin1 and decreased PNI were closely associated with poor prognosis in HBV-ACLF patients,and serum Beclin1 level combined with PNI had a high predictive value for poor prognosis in HBV-ACLF patients.