甲胎蛋白在乙型肝炎病毒感染相关慢加急性肝衰竭诊治中的价值

Value of alpha-fetoprotein on the diagnosis and treatment of hepatitis B virus infectionrelated acute-on-chronic liver failure

乙型肝炎病毒感染相关慢加急性肝衰竭(hepatitis B virus infection-related acute liver failure,HBV-ACLF)是在乙型肝炎病毒(hepatitis B virus,HBV)感染导致的慢性肝炎和终末期肝病基础上发生的以肝脏功能急性衰竭为特征的临床综合征,是中国最主要的肝衰竭类型,短期死亡率极高。基础研究发现甲胎蛋白(alpha fetoprotein,AFP)水平与HBV-ACLF短期预后相关,可用于预测肝衰竭患者的短期预后。临床研究发现由中性粒细胞、乙型肝炎病毒表面抗原和AFP组成的NHA-ACLF模型,由总胆红素、年龄、血肌酐、国际标准化比值和AFP组成的TACIA评分模型,含AFP的人工肝支持系统-预后模型(APM)以及AFP的四分位数分层等对HBV-ACLF短期预后预测价值优于单用AFP。

Hepatitis B virus infection-related acute liver failure(HBV-ACLF)was a clinical syndrome characterized by acute liver failure on the basis of chronic hepatitis and end-stage liver disease caused by hepatitis B virus(HBV)infection,which was the main type of liver failure in China and with extremely high short-term mortality.Basic research had found that the level of AFP was related to the short-term prognosis of HBV-ACLF,which could be used to predict the short-term prognosis of patients with liver failure.Clinical studies had found that the NHA-ACLF model(comprising neutrophils,hepatitis B virus surface antigen and AFP),the TACIA scoring model(including total bilirubin,age,serum creatinine,international normalized ratio and AFP),the artificial liver support system prognosis model incorporating AFP(APM),and AFP quartile stratification all provided superior predictive value for short-term prognosis in patients with HBV-ACLF compared to AFP alone.