游离三碘甲状腺原氨酸在戊型肝炎相关急性肝衰竭患者预后评估价值研究  

Prognostic value of serum free triiodothyronine in patients with hepatitis E-related acute liver failure

作　　者：王滢[1,2] 向泽 童玲 翟光华 江春[5] 黄蓝 俞炯 鹿娟 曹红翠[6] 吴健 Wang Ying;Xiang Ze;Tong Ling;Zhai Guanghua;Jiang Chun;Huang Lan;Yu Jiong;Lu Juan;Cao Hongcui;Wu Jian(Department of Infection Management,Suzhou Municipal Hospital,Suzhou 215008,Jiangsu Province,China;The Chinese Consortium for the Study of Hepatitis E,Suzhou 215008,Jiangsu Province,China;Zhejiang University School of Medicine,Hangzhou 310012,China;Clinical Laboratory,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Clinical Laboratory,Suzhou Municipal Hospital,Suzhou 215008,Jiangsu Province,China;State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases,National Clinical Research Center for Infectious Diseases,the First Affiliated Hospitale,Zhejiang University School of Medicine,Hangzhou 310003,China)

机构地区：[1]苏州市立医院感染管理科,215008 [2]中国戊型肝炎研究协助组,苏州215008 [3]浙江大学医学院,杭州310012 [4]浙江大学医学院附属第一医院检验科,杭州310003 [5]苏州市立医院检验科,215008 [6]浙江大学医学院附属第一医院传染病诊治国家重点实验室、国家感染性疾病临床医学研究中心感染性疾病诊治协同创新中心,杭州310003

出　　处：《中华临床感染病杂志》2022年第5期345-351,共7页Chinese Journal of Clinical Infectious Diseases

基　　金：国家自然科学基金面上项目(82272396);浙江省“领雁”研发攻关计划项目(2022C03G2013730);浙江大学基本科研专项基金(226-2022-00061、2022ZFJH003)。

摘　　要：目的分析血清游离三碘甲状腺原氨酸(FT3)在戊型肝炎相关急性肝衰竭(HEV-ALF)患者的预后价值。方法回顾性分析中国戊型肝炎研究协助组成员单位2016年1月至2021年12月收治的88例HEV-ALF患者、86例急性戊型肝炎(AHE)患者临床资料,同期收集苏州市立医院健康体检中心100名健康体检者资料。分析不同人群血清FT3水平。根据30d的生存情况,将HEV-ALF患者分为生存组(n=73)和死亡组(n=15)。通过Cox回归分析以及正交偏最小二乘判别分析(OPLS-DA)血清FT3水平与HEV-ALF患者预后的关系。采用受试者工作特征曲线(ROC)和决策曲线分析(DCA)评价血清FT3的预测能力和决策能力,并与常规MELD、KCH和Child-Pugh模型进行比较。结果HEV-ALF患者血清FT3水平低于AHE患者和健康人群(P=0.006或<0.001)。Cox回归分析显示,国际标准化比值(HR=17.984,95%CI 2.804~115.362)、肝性脑病(HR=12.895,95%CI 2.386~69.695)和总胆固醇(HR=2.448,95%CI 1.108~5.409)是HEV-ALF患者死亡的独立危险因素,而血清FT3水平(HR=0.323,95%CI 0.119~0.876)是HEV-ALF患者死亡的保护因素。OPLS-DA显示,血清FT3水平具有较高预测价值。ROC曲线分析显示,血清FT3水平的曲线下面积为0.828(95%CI 0.733~0.900,P<0.001),敏感度为80.00%,特异度为78.08%。DCA曲线显示FT3水平具有较好的预测能力和决策水平。病情好转和波动患者血清FT3水平均高于恶化患者(P<0.05或<0.01)。结论血清FT3水平与HEV-ALF患者预后密切相关,有望成为HEV-ALF患者预后的有效生物标志物。Objective To investigate the prognostic value of serum free triiodothyronine(FT3)in patients with hepatitis E-related acute liver failure(HEV-ALF).Methods Clinical data of 88 patients with HEV-ALF and 86 patients with acute hepatitis E(AHE)were collected from the member hospitals of Chinese Consortium for the Study of Hepatitis E between January 2016 and December 2021;the data of 100 health subjects who underwent health check-up in Suzhou Municipal Hospital were also collected as healthy control(HC)group.Serum FT3 levels were analyzed in all subjects.HEV-ALF patients were divided into survival group(n=73)and death group(n=15)according to their 30 day survival.Correlation between serum FT3 level and prognosis of HEV-ALF patients were analyzed by Cox regression and orthogonal partial least squares discriminant analysis(OPLS-DA).The receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to assess the predictive value of serum FT3 levels for predicting the prognosis of patients,and its prediction efficacy was compared with conventional Model for End-Stage Liver Disease(MELD),King’s College Hospital criteria(KCH)and Child-Pugh models.Results The levels of serum FT3 in HEV-ALF patients were significantly lower than those in AHE patients and HC group(P=0.006 or<0.001).Cox regression analysis showed that international standardized ratio(HR=17.984,95%CI 2.804-115.362),hepatic encephalopathy(HR=12.895,95%CI 2.386-69.695)and total cholesterol(HR=2.448,95%CI 1.108-5.409)were independent risk factors for death in HEV-ALF patients,and serum FT3 level(HR=0.323,95%CI 0.119-0.876)was a protective factor.OPLS-DA results showed serum FT3 levels had high predictive value.ROC curve analysis results showed that the area under the curve was 0.828(95%CI 0.733-0.900,P<0.001),the sensitivity was 80.00%,and the specificity was 78.08%.DCA showed that FT3 has good prediction ability and decision-making level serum FT3 levels in patients with improvement and fluctuation were significantly higher than those in

关 键 词：戊型肝炎 急性肝衰竭 游离三碘甲状腺原氨酸 预后 

分 类 号：R575.3[医药卫生—消化系统] R512.6[医药卫生—内科学]