抗凝血酶Ⅲ活性检测在HBV相关慢加急性肝衰竭中的意义  

Significance of AntithrombinⅢactivity in hepatitis B virus related acute-on-chronic liver failure

作　　者：王爱华[1] 管世鹤[1] 杨凯[1] 王琴[1] 周强[1] 陈礼文[1] 张浩[1] 孙蓓蓓[1] Wang Aihua;Guan Shihe;Yang Kai(Dept of Laboratory Medicine,The Second Affiliated Hospital of Anhui Medical University,Hefei 230601)

机构地区：[1]安徽医科大学第二附属医院检验科,合肥230601

出　　处：《安徽医科大学学报》2021年第3期480-485,共6页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金面上项目(编号:81972013)。

摘　　要：目的分析HBV相关慢加急肝衰竭患者(HBVACLF)抗凝血酶原Ⅲ(AT-Ⅲ)活性变化,研究其与患者肝功能及凝血功能指标潜在相关性。方法选取住院患者中诊断明确的HBV-ACLF患者80例和作为对照的慢性乙型肝炎(CHB)患者48例,发色底物法分析患者AT-Ⅲ活性水平,采用Spearman秩相关分析其与血清总胆红素水平(TBIL)、白蛋白(ALB)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、凝血酶原活动度(PTA),PT国际标准化比值(PTINR)及终末期肝病模型(MELD)评分的相关性,运用受试者工作特征(ROC)曲线评价AT-Ⅲ能否作为影响HBV-ACLF临床预后的潜在实验室检测指标。结果与CHB患者相比,HBV-ACLF患者AT-Ⅲ活性水平降低,其它肝功能和凝血功能检测指标除ALB和PTA减少外均增加,差异有统计学意义(P<0.05)。HBV-ACLF患者AT-Ⅲ活性水平与TBIL、PT-INR、PTA均具有相关性,HBV-ACLF患者预后分组中AT-Ⅲ活性水平与MELD评分呈负相关,ROC曲线结果显示,采用AT-Ⅲ预测HBV-ACLF患者临床预后的曲线下面积为0.686,敏感性为75.0%,特异性为52.9%,界值为16.4%;采用MELD评分预测HBV-ACLF患者临床预后的曲线下面积为0.698,敏感性76.5%,特异性55.9%,界值为28.5;AT-Ⅲ联合MELD评分预测HBV-ACLF患者临床预后的曲线下面积为0.756,敏感性为62.5%,特异性为88.2%,界值为AT-Ⅲ:20.1%,MELD评分:25。结论AT-Ⅲ与HBV-ACLF患者肝功能损伤严重程度、病情进展相关,临床联合MELD评分在预测HBV-ACLF患者临床预后方面具有一定的参考价值。Objective To analyze the changes of AntithrombinⅢ(AT-Ⅲ)activity in patients with HBV-related acute liver failure(HBV-ACLF)and to study its potential correlation with liver function and coagulation function.Methods 80 subjects with HBV-ACLF and 48 subjects with chronic hepatitis B(CHB)as the controls were enrolled in our hospital.The level of AT-Ⅲwas detected with chromogenic substrate method,the relationships between AT-Ⅲand total bilirubin(TBIL),albumin(ALB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),prothrombin time activity(PTA),international normalized ratio of prothrombin time(PT-INR)and end-stage liver disease(MELD)score were analyzed by using Spearman rank correlation,and the receiver operating characteristic(ROC)curve was used to evaluate whether AT-Ⅲcould be used as a laboratory test to influence the clinical prognosis of HBV-ACLF.Results The activity level of AT-Ⅲin patients with HBV-ACLF decreased than those of patients with CHB.Compared with CHB patients,other markers of liver function and coagulation function increased except for the decrease of ALB and PTA in patients with HBV-ACLF,and the differences were significant(P<0.05).The level of AT-Ⅲactivity was correlated with TBIL,PT-INR and PTA in patients with HBV-ACLF.And it was negatively correlated with MELD score in the prognosis of patients with HBV-ACLF.The ROC curve showed that the area under the curve predicted by AT-Ⅲwas 0.686,the sensitivity was 75.0%,the specificity was 52.9%,and the boundary value was 16.4%;the area under the curve predicted by MELD core was 0.698,the sensitivity was 76.5%,the specificity was 55.9%,and the boundary value was 28.5;the area under the curve predicted by MELD core and AT-Ⅲwas 0.756,the sensitivity was 62.5%,the specificity was 88.2%,the boundary value were 25 and 20.1%.Conclusion AT-Ⅲis associated with the severity and progression of liver injury in patients with HBV-ACLF.The clinical combination of AT-Ⅲand MELD score is useful in predicting the prognosis of HBV-ACLF.

关 键 词：抗凝血酶原Ⅲ 慢加急性肝衰竭 慢性乙型肝炎 

分 类 号：R392.7[医药卫生—免疫学] R446.11[医药卫生—基础医学]