血清壳多糖酶3样蛋白1水平与乙型肝炎病毒相关慢加急性肝衰竭患者临床预后的相关性分析

Correlation between serum chitinase 3-like protein 1 level and clinical prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure

目的探讨血清壳多糖酶3样蛋白1(CHI3L1)水平与乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者临床预后的相关性。方法本研究为病例对照研究,选取2019年12月至2022年12月烟台市莱阳中心医院感染科收治的80例HBV-ACLF患者作为HBV-ACLF组,男47例,女33例,年龄(48.36±5.56)岁,年龄范围为25~74岁,另选取同期来烟台市莱阳中心医院体检中心体检的80名健康体检者作为健康组。根据是否发生病死事件将HBV-ACLF组患者分为生存组(n=52)与病死组(n=28)。采用双抗体夹心法酶联免疫吸附实验检测血清CHI3L1水平;采用受试者工作特性曲线评估血清CHI3L1对HBV-ACLF患者预后的预测价值;采用多因素logistic回归分析探讨HBV-ACLF患者预后的影响因素。结果HBV-ACLF组血清CHI3L1水平[(69.45±6.85)μg/L]高于健康组[(47.43±4.46)μg/L],病死组血清CHI3L1水平[(96.14±9.65)μg/L]高于生存组[(55.08±5.34)μg/L],差异有统计学意义(P<0.001)。血清CHI3L1预测HBV-ACLF患者临床预后的曲线下面积为0.854(95%CI:0.806~0.902,P<0.001),截断值为75.60μg/L,灵敏度为84.18%,特异度为86.74%。国际标准化比值≥2.27、终末期肝病模型评分≥23.68分、血清CHI3L1≥75.60μg/L是HBV-ACLF患者病死的影响因素。结论CHI3L1水平升高与HBV-ACLF发生发展密切相关,可作为评估HBV-ACLF患者预后的生物学指标。

Objective To explore the correlation between serum chitinase 3-like protein 1(CHI3L1)level and clinical prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods This study was a case-control study.A total of 80 HBV-ACLF patients admitted to the department of Infection in Yantai Laiyang Central Hospital from December 2019 to December 2022 were selected as the HBV-ACLF group,including 47 males and 33 females,aged(48.36±5.56)years old,ranging from 25 to 74 years old.In addition,a total of 80 healthy subjects who came to the physical examination center of Yantai Laiyang Central Hospital during the same period were selected as the health group.HBV-ACLF patients were divided into survival group(n=52)and disease death group(n=28)according to the occurrence of death events.The serum CHI3L1 levels were detected by double antibody sandwich enzyme-linked immunosorbent assay.The predictive value of serum CHI3L1 in the prognosis of HBV-ACLF patients was evaluated by receiver operator characteristic curve.Multivariate logistic regression analysis was used to investigate the prognostic factors of HBV-ACLF patients.Results The serum CHI3L1 level in HBV-ACLF group[(69.45±6.85)μg/L]was higher than that in healthy group[(47.43±4.46)μg/L],and the serum CHI3L1 level in disease death group[(96.14±9.65)μg/L]was higher than that in survival group[(55.08±5.34)μg/L].The differences were statistically significant(P<0.001).The area under the curve of serum CHI3L1 was 0.854(95%CI:0.806 to 0.902,P<0.001),the cutoff value was 75.60μg/L,the sensitivity was 84.18%,and the specificity was 86.74%for predicting the prognosis of HBV-ACLF patients.International normalized ratio≥2.27,model of end-stage liver disease score≥23.68 scores,serum CHI3L1≥75.60μg/L were the influencing factors of death in HBV-ACLF patients.Conclusions Elevated CHI3L1 level is closely related to the occurrence and development of HBV-ACLF,which can be used as a biological indicator to evaluate the prognosis of HBV-ACLF patients.