mAST/ALT对严重发热伴血小板减少综合征患者预后的预测价值

Predictive value of mitochondrial AST/ALT on prognosis of patients with severe fever and thrombocytopenia syndrome

目的探讨线粒体天门冬氨酸氨基转移酶(mAST)/丙氨酸转氨酶(ALT)与严重发热伴血小板减少综合征(SFTS)患者生存的相关性,并探讨其在诊断SFTS患者预后中的应用价值。方法选取2021年1月~2023年1月在我院确诊的317例SFTS患者,将全部SFTS患者和入住重症监护室(ICU)患者入院1周内的临床特征进行对比,使用Logistic多元回归分析影响全部SFTS患者和入住ICU患者死亡的独立危险因素,分析mAST/ALT在SFTS患者预后评估中的应用价值。结果死亡组的年龄、碱性磷酸酶(ALP)、ALT、AST、AST/ALT、胞质AST(cAST)、cAST/ALT、mAST、mAST/ALT、肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)、γ-谷氨酰基转移酶(GGT)、α-羟基丁酸脱氢酶(α-HBDH)水平均高于生存组(P<0.05);入住ICU死亡者的年龄、AST、cAST、mAST、AST/ALT、cAST/ALT、mAST/ALT、CK及α-HBDH水平均明显高于幸存者(P<0.05);Logistic多元回归分析显示,年龄、α-HBDH、AST/ALT、cAST/ALT及mAST/ALT是所有SFTS患者死亡的独立危险因素(P<0.05),而AST/ALT、cAST/ALT及mAST/ALT是入住ICU患者死亡的独立危险因(P<0.05),且mAST/ALT的OR值最高;绘制受试者工作特征(ROC)曲线,上述参数的AUC值均大于0.7,有一定预测价值,且mAST/ALT的特异性和灵敏度最高,预后预测价值最好。结论AST/ALT、cAST/ALT及mAST/ALT水平和SFTS患者预后有关,其中mAST/ALT水平对重症SFTS患者预后价值最好。

Objective To observe the correlation between mitochondrial aspartate aminotransferase(mAST)/alanine aminotransferase(ALT)and the survival time of patients with severe fever and thrombocytopenia syndrome(SFTS),and explore its application value in diagnosing the prognosis of patients with SFTS.Methods 317 patients with SFTS diagnosed in our hospital from Jan 2021 to Jan 2023 were selected,and the clinical characteristics of all SFTS patients and survivors and deaths admitted to intensive care unit(ICU)were compared within one week after admission.Logistic multiple regression was used to analyze the independent death risk factors of all SFTS patients and patients admitted to ICU,and the application value of mAST/ALT in prognosis evaluation of SFTS patients was analyzed.Results The average age and level of ALP,AST,ALT,AST/ALT,cytoplasmic aspartate aminotransferase(cAST),cAST/ALT,mAST,mAST/ALT,CK-MB,creatine kinase(CK),GGT,andα-hydroxybutyrate dehydrogenase(α-HBDH)in the death group were higher than those in the survival group(P<0.05).And age,levels of AST,cAST,AST/ALT,cAST/ALT,mAST/ALT,CK andα-HBDH of the dead patients in ICU were significantly higher than those in the survivors(P<0.05).Logistic multiple regression analysis showed that age,α-HBDH,AST/ALT,cAST/ALT and mAST/ALT were the independent risk factors for death in all SFTS patients(P<0.05),while the AST/ALT,cAST/ALT and mAST/ALT were independent risk factors for mortality in ICU patients(P<0.05),and the OR value of mAST/ALT was the highest.Drawn ROC curve,the AUC values of the above parameters were all greater than 0.7,which had certain predictive value,and mAST/ALT had the highest specificity and sensitivity,with the best prognostic predictive value.Conclusion The levels of AST/ALT,cAST/ALT and mAST/ALT are related to the prognosis of patients with SFTS,with the level of mAST/ALT has the prognostic value for patients with severe SFTS.