血清吡咯蛋白加合物对吡咯生物碱相关肝窦阻塞综合征的严重度评估和对抗凝疗效的预测价值  

The role of serum pyrrole-protein adduct in evaluating the severity and predicting the anticoagulant efficacy in patients with pyrroidine alkaloid-related hepatic sinusoidal obstruction syndrome

作　　者：王烜 张玮[1] 王汛江 张明[1] 张峰[1] 肖江强[1] 殷芹[1] 杨莉[2] 诸葛宇征[1] Wang Xuan;Zhang Wei;Wang Xunjiang;Zhang Ming;Zhang Feng;Xiao Jiangqiang;Yin Qin;Yang Li;Zhuge Yuzheng(Department of Gastroenterology,Drum Tower Hospital,Affiliated Medical College of Nanjing University,Nanjing210008,China;The Key Laboratory of Ministry of Education for Standardization of Chinese Medicines and the State Administration of Traditional Chinese Medicine,Shanghai Key Laboratory for Compound Traditional Chinese Medicine,Institute of Chinese Materia Medica,Shanghai University of Traditional Chinese Medicine,Shanghai201203,China)

机构地区：[1]南京大学医学院附属鼓楼医院消化内科,南京210008 [2]上海中医药大学中药研究所中药标准化教育部重点实验室暨上海市复方中药重点实验室,上海201203

出　　处：《中华消化杂志》2022年第2期111-118,共8页Chinese Journal of Digestion

基　　金：南京卫生科技发展重点项目(ZKX19015)。

摘　　要：目的探究血清吡咯蛋白加合物(PPA)对吡咯生物碱相关肝窦阻塞综合征(PA-HSOS)的严重度评估和对抗凝疗效的预测价值。方法收集南京大学医学院附属鼓楼医院2018年4月至2019年12月收治的48例PA-HSOS确诊患者资料,包括PPA浓度、门静脉流速、腹水分级、PA-HSOS严重度分级(参考欧洲血液和骨髓移植协作组成人可疑肝窦阻塞综合征新严重度分级标准并进行调整)和抗凝结局。以急性起病(食用含吡咯生物碱植物1个月内出现症状)患者为研究对象,经logistic回归分别拟合PPA联合门静脉流速、腹水分级的PA-HSOS严重度评估模型,计算2种联合模型的logit值,公式分别为logit_(1)=0.034×PPA(nmol/L)+0.055×门静脉流速(cm/s)-3.287,logit_(2)=0.039×PPA(nmol/L)-2.712×2级腹水(有=1,无=0)-0.388×3级腹水(有=1,无=0)-0.899。以在南京大学医学院附属鼓楼医院行初次抗凝治疗的患者为研究对象,经logistic回归拟合PPA联合血清肌酐和肝静脉压力梯度(HVPG)的抗凝疗效预测模型,计算logit值,公式为logit_(3)=0.013×PPA(nmol/L)+0.064×血清肌酐(mol/L)+0.542×HVPG(mmHg,1 mmHg=0.133 kPa)-16.005。评价PPA对PA-HSOS严重度评估效能和对抗凝疗效的预测价值。统计学方法采用受试者操作特征曲线分析。结果48例患者的血清PPA水平为10.81 nmol/L(3.91 nmol/L,32.04 nmol/L),其中PA-HSOS轻度患者33例(68.8%),中度患者3例(6.2%),重度患者0例,极重度患者12例(25.0%)。23例在南京大学医学院附属鼓楼医院行初次抗凝治疗且有完整数据的患者中,8例应答且存活,15例无应答(5例死亡,1例继续行抗凝治疗后缓解,9例转行抗凝-经颈静脉肝内门体静脉分流术治疗后均存活);1例最初未行抗凝治疗的患者,最终因病情进展行抗凝-经颈静脉肝内门体静脉分流术治疗后存活。PPA评估急性起病患者PA-HSOS严重度的曲线下面积(AUC)为0.75,95%置信区间(CI)0.52~0.98(P=0.047);当PPA≥45.519 nmol/L,评估重度以�Objective To explore the role of serum pyrrole-protein-adduct(PPA)in evaluating the severity and predicting the anticoagulant efficacy in patients with pyrrolidine alkaloid-related hepatic sinusoidal obstruction syndrome(PA-HSOS).Methods From April 2018 to December 2019,the data of 48 patients with PA-HSOS admitted and treated at Drum Tower Hospital,Affiliated Medical College of Nangjing University were collected,which included PPA level,portal vein velocity(PVV),ascites grading,PA-HSOS severity grading(according to the new severity grading criteria for suspected hepatic sinusoidal obstruction syndrome in adults by the European Society of Blood and Bone Marrow Transplantation and adjusted)and the outcome of anticoagulation.Patients with acute onset(onset of symptoms within 1 month after consuming pyrrolizidine alkaloid-containing plants)were taken as research subjects.The combination of PPA with PVV or with ascites classification of PA-HSOS severity assessment model was fitted by logistic regression,and the logit values of 2 combination models were calculated,the formula was logit_(1)=0.034×PPA(nmol/L)+0.055×PVV(cm/s)-3.287,logit_(2)=0.039×PPA(nmol/L)-2.712×ascites grade 2(Yes=1,No=0)-0.388×ascites grade 3(Yes=1,No=0)-0.899.The patients received initial anticoagulation therapy at Drum Tower Hospital,Affiliated Medical College of Nanjing University were selected as research subjects.The anticoagulant efficacy prediction model of combination of PPA with serum creatinine(SCR)and with hepatic venous pressure gradient(HVPG)was fitted by logistic regression,and the logit value was calculated,the formula was logit_(3)=0.013×PPA(nmol/L)+0.064×SCR(mol/L)+0.542×HVPG(mmHg,1 mmHg=0.133 kPa)-16.005.The predictive value of PPA in evaluating the severity of PA-HSOS and anticoagulant efficacy was evaluated.Receiver operating characteristic curve analysis was performed for statistical analysis.Results The serum PPA level of 48 patients was 10.81 nmol/L(3.91 nmol/L,32.04 nmol/L).Among them,33 cases(68.8%)were mild PA-HSOS,

关 键 词：血清吡咯蛋白加合物 肝窦阻塞综合征 严重度评估 抗凝疗效预测 

分 类 号：R575[医药卫生—消化系统]