慢加急性肝衰竭前期患者血清M30和M65水平预测预后价值探讨  

Serum M30 and M65 levels in patients with acute-on-chronic pre-liver failure

作　　者：黄小平[1] 吴云辉 王艳[1] 甘建和[1] 

机构地区：[1]苏州大学附属第一医院感染病科,江苏省苏州市215006 [2]浙江省嘉兴县人民医院感染病科

出　　处：《实用肝脏病杂志》2016年第3期301-304,共4页Journal of Practical Hepatology

基　　金："十二五"国家传染病科技重大专项(2012ZX10002-004)

摘　　要：目的探讨慢加急性肝衰竭前期(pre-ACLF)患者血清M30和M65水平在早期诊断慢加急性肝衰竭(ACLF)患者的价值。方法采用ELISA法检测35例pre-ACLF患者(痊愈20例、进展15例)、40例HBV相关ACLF患者(生存20例,死亡20例)、20例慢性乙型肝炎患者(CHB)和20例健康对照者血清M30和M65水平,分析其对pre-ACLF及ACLF患者临床转归的预测价值。结果 ACLF组和pre-ACLF组血清M30和M65水平均显著高于健康对照组或CHB患者,ACLF组显著高于pre-ACLF组(P<0.05);pre-ACLF进展组血清M30和M65[分别为(493.80±143.85)U/L和(712.47±305.67)U/L],与痊愈组[分别为(351.40±127.78)U/L和(448.15±165.14)U/L]比,差异具有统计学意义(P<0.05);pre-ACLF进展组与ACLF患者比,血清M30和M65水平[分别为(503.29±184.43)U/L和(746.99±275.19)U/L],均无显著性差异(P>0.05);以血清M30和M65水平鉴别诊断Pre-ACLF临床转归的ROC曲线下面积(AUC)分别为0.877和0.867;当M30≥453.70 U/L时,其预测预后的灵敏度和特异度分别为0.867和0.850;当M65≥626.71 U/L时,其早期预测ACLF的灵敏度和特异度分别为0.800和0.850。死亡的ACLF患者血清M30和M65水平虽高于ACLF好转组,但差异无统计学意义。结论 M30和M65是反应肝衰竭及肝衰竭前期患者肝细胞坏死或凋亡较敏感的指标,可用于早期诊断ACLF。Objective To evaluate serum M30 and M65 levels in patients with acute-on-chronic pre-liver failure （pre-ACLF） and to investigate their value for early diagnosis of acute-on-chronic liver failure （ACLF）. Methods Serum M30 and M65 levels in patients with pre-ACLF （n=35）,ACLF （n=40）,chronic hepatitis B （CHB,n=20） and healthy controls （n=20） were determined by enzyme-linked immunoabsorbent assay. The clinical significance for early diagnosis of ACLF was analyzed. Results Significantly higher serum M30 and M65 levels were found in patients with ACLF and with pre-ACLF compared with CHB or healthy controls （P〈0.05）;In pre- ACLF patients,serum M30 and M65 levels [（493.80±143.85）U/L and （712.47±305.67） U/L] were higher in 15 patients who progressed to ACLF than 20 recovered [（351.40±127.78）U/L and（448.15±165.14） U/L,respeetively, P〈0.05];No significant difference was found in serum M30 and M65 levels between 15 patients with pre-ACLF who switched to ACLF and 40 patients with ACLF（P〉0.O5）;The area under receiver operating characteristic curve （AUC） demonstrated that both serum M30 and M65 had diagnostic value （AUC≥0.80） in identifying early ACLF from pre-ACLF patients（0.877 and 0.867,respectively）;When serum M30 levels were 〉1453.70 U/L,the sensitivity and specificity for diagnosis of ACLF was 0.867and 0.850,respectively,and when serum M65 levels were ≥ 626.71 U/L,the sensitivity and specificity for diagnosis of ACLF was 0.800 and 0.850,respectively;No significant difference was found in serum M30 and M65 levels between 20 survived patients with ACLF as compared with 20 died （P〉0.05）. Conclusions In patients with pre-ACLF,serum M30 and M65 levels may serve as important biomarkers for early diagnosis of ACLF.

关 键 词：慢加急性肝衰竭 慢加急性肝衰竭前期 早期诊断 M30抗原 M65抗原 

分 类 号：R575.3[医药卫生—消化系统]