血清sST2联合MELD评分等多指标在ALSS治疗前预测乙型肝炎病毒相关慢加急性肝衰竭患者治疗结局

Serum sST2 combined with MELD score and other indicators before ALSS therapy predict the treatment outcome of hepatitis B virus-related acute-on-chronic liver failure patients

目的探讨人工肝支持系统(ALSS)治疗前血清可溶性致瘤抑制蛋白2(sST2)与乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者治疗结局的关系。方法选取2017年10月至2021年7月苏州大学附属传染病医院收治并经过ALSS治疗的HBV-ACLF患者30例为HBV-ACLF组,乙型肝炎病毒相关肝硬化(HBV-LC)患者20例为HBV-LC组,另选取该院体检健康者25例作为对照组。采用酶联免疫吸附试验检测血清sST2、白细胞介素(IL)-2、IL-12、IL-17、干扰素(IFN)-γ水平,收集相关临床数据并采用受试者工作特征(ROC)曲线、Kaplan-Meier生存曲线分析各指标和患者治疗结局的关系。结果血清sST2水平在HBV-ACLF组中升高,明显高于对照组和HBV-LC组(P<0.05)。利用ROC曲线获得sST2最佳临界值,并根据其将30例HBV-ACLF患者分为高值组和低值组,结果发现低值组患者30 d生存率明显高于高值组(P<0.05)。sST2联合终末期肝病模型(MELD)评分和炎症相关指标IL-12具有较高的预测价值,其曲线下面积为0.775,明显高于其他指标联合检测结果。结论外周血sST2水平可以预测ALSS疗效,sST2联合MELD评分和IL-12可以有效预测ALSS治疗效果,提示sST2可作为一种新型生物标志物协助临床预测ACLF患者治疗结局。

Objective To investigate the relationship between serum soluble tumor suppressor protein 2(sST2)and the treatment outcome of hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)patients before artificial liver support system(ALSS)treatment.Methods A total of 30 patients with HBVACLF treated with ALSS in the Affiliated Infectious Diseases Hospital of Soochow University from October 2017 to July 2021 were selected as the HBV-ACLF group.A total of 20 patients with hepatitis B virus-related liver cirrhosis(HBV-LC)were selected as HBV-LC group,and 25 healthy people were selected as control group.Enzyme-linked immunosorbent assay was used to detect serum sST2,interleukin(IL)-2,IL-12,IL-17,interferon(IFN)-γlevels.The relevant clinical data were collected,and the receiver operating characteristic(ROC)curve and Kaplan-Meier survival curve were used to analyze the relationship between the indicators and the treatment outcome of patients.Results Serum sST2 level in HBV-ACLF group was significantly higher than that in control group and HBV-LC group(P<0.05).According to the optimal cut-off value of sST2 obtained by ROC curve,30 patients with HBV-ACLF were divided into high-value group and low-value group.The results showed that the 30 d survival rate of patients in the low-value group was significantly higher than that in the high-value group(P<0.05).sST2 combined with model for end-stage liver disease(MELD)score and IL-12 had a high predictive value,and the area under the curve was 0.775,which was significantly higher than that of other indicators.Conclusion Peripheral blood sST2 level could predict the therapeutic effect of ALSS,and sST2 combined with MELD score and IL-12 could effectively predict the therapeutic effect of ALSS,suggesting that sST2 could be used as a new biomarker to predict the therapeutic outcome of ACLF patients.