慢加急性乙型肝炎肝衰竭患者血清聚集素水平变化及其临床意义探讨  

Serum clusterin levels in patients with hepatitis B virus-related acute-on-chronic liver failure and its correlation with short-term prognosis

作　　者：王明强 牛垚飞 王生锋[3] Wang Mingqiang;Niu Yaofei;Wang Shengfeng(Central Intensive Care Unit,Henan Provincial People's Hospital,Zhengzhou 450003,Henan Province,China)

机构地区：[1]河南省人民医院中心ICU,郑州市450003 [2]河南省人民医院感染ICU,郑州市450003 [3]郑州大学第二附属医院重症医学科

出　　处：《实用肝脏病杂志》2022年第5期677-680,共4页Journal of Practical Hepatology

基　　金：河南省科技攻关计划项目(编号:162300410294)。

摘　　要：目的探讨慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者血清聚集素水平变化及其临床意义。方法2019年1月~2021年1月我院收治住院的HBV-ACLF患者48例和同期入院诊治的慢性乙型肝炎(CHB)患者60例,采用ELISA法检测血清聚集素水平。结果HBV-ACLF组外周血白细胞计数、血清ALT、AST、TBIL和MELD评分分别为(8.0±2.8)×10^(9)/L、(418.2±163.5)U/L、(386.1±139.2)U/L、(226.6±74.4)μmol/L和(23.2±5.3),显著高于CHB组【分别为(6.0±2.3)×10^(9)/L、(163.8±75.7)U/L、(118.7±73.3)U/L、(25.6±12.4)μmol/L和(9.6±3.6),P<0.05】,而外周血PLT计数为(101.8±42.0)×10^(9)/L,血清Alb水平为(32.6±7.6)g/L,PTA为(35.3±5.3)%,血清聚集素水平为(51.0±5.9)μg/mL,显著低于CHB组【分别为(128.5±54.4)×10^(9)/L、(38.1±8.5)g/L、(77.4±9.3)%和(185.9±13.5)μg/mL,P<0.05】;9例HBV-ACLF晚期患者血清凝集素水平为(28.5±3.8)μg/mL,显著低于20例早期【(72.6±7.2)μg/mL,P<0.05】或19例中期【(46.0±5.2)μg/mL,P<0.05】患者,13例感染患者血清凝集素水平为(36.6±4.6)μg/mL,显著低于35例无感染患者【(56.6±6.1)μg/mL,P<0.05】,15例死亡患者血清凝集素水平为(39.8±4.3)μg/mL,显著低于33例生存患者【(72.3±7.6)μg/mL,P<0.05】;死亡患者血清总胆红素水平更高,MELD评分更高,PTA更低,并发肝性脑病为46.7%,并发肝肾综合征为40.0%,与生存患者比,差异显著(P<0.05)。结论HBV-ACLF患者血清聚集素降低,其降低程度与预后相关,是否可作为一种潜在的生物标志物用于评估HBV-ACLF患者病情的严重程度和预后,值得进一步研究。Objective This study aimed to explore serum clusterin level changes in patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)and its correlation with short-term prognosis.Methods 48 hospitalized patients with HBV-ACLF and 60 patients with chronic hepatitis B(CHB)were enrolled in our hospital between January 2019 and January 2021,and the patients with HBV-ACLF were classified into early stage with 30%<prothrombin time activity(PTA)<40%,middle stage with 20%<PTA<30%and late stage with PTA<20%.Serum clusterin levels were assayed by ELISA.Results The peripheral white blood cell counts,serum alanine aminotransferase,aspartate aminotransferase,bilirubin levels and model for the end-stage liver diseases(MELD)in patients with HBV-ACLF were(8.0±2.8)×10^(9)/L,(418.2±163.5)U/L,(386.1±139.2)U/L,(226.6±74.4)μmol/L and(23.2±5.3),significantly higher than[(6.0±2.3)×10^(9)/L,(163.8±75.7)U/L,(118.7±73.3)U/L,(25.6±12.4)μmol/L and(9.6±3.6),respectively,P<0.05],while peripheral platelet counts was(101.8±42.0)×10^(9)/L,serum albumin level was(32.6±7.6)g/L,PTA was(35.3±5.3)%,serum clusterin level was(51.0±5.9)μg/mL,all significantly lower than[(128.5±54.4)×10^(9)/L,(38.1±8.5)g/L,(77.4±9.3)%and(185.9±13.5)μg/mL,respectively,P<0.05]in patients with CHB;serum clusterin level in 9 patients with HBV-ACLF late stage was(28.5±3.8)μg/mL,significantly lower than[(72.6±7.2)μg/mL,P<0.05]in 20 patients with HBV-ACLF early stage or[(46.0±5.2)μg/mL,P<0.05]in 19 patients with HBV-ACLF middle stage,serum clusterin level in 13 HBV-ACLF patients with bacterial infections was(36.6±4.6)μg/mL,significantly lower than[(56.6±6.1)μg/mL,P<0.05]in 35 HBV-ACLF patients without infections,and serum clusterin level in 15 dead HBV-ACLF patients was(39.8±4.3)μg/mL,significantly lower than[(72.3±7.6)μg/mL,P<0.05]in 33 survivals;the dead patients with HBV-ACLF had even more higher total serum bilirubin levels,elevated MELD scores,more lower PTA,and more the incidence of complications,such as hepatic en

关 键 词：慢加急性肝衰竭 血清聚集素 预后 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]