血清氨甲酰磷酸合成酶1在戊型肝炎急性肝衰竭患者的表达及其预后价值  

Prognostic value of serum carbamoyl phosphate synthase 1 in patients with hepatitis E-related acute liver failure

作　　者：吴健[1] 向泽 翟光华[1] 商安全 梁炜 李冬[3] Jian Wu;Ze Xiang;Guanghua Zhai;Anquan Shang;Wei Liang;Dong Li(Department of Clinical Laboratory,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Gusu School,Nanjing Medical University,Suzhou 215008,China;The First Affiliated Hospital,College of Medicine,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Clinical Laboratory,Shanghai Tongji Hospital,School of Medicine,Tongji University,Shanghai 200065,China)

机构地区：[1]南京医科大学附属苏州医院检验科,苏州215008 [2]浙江大学医学院附属第一医院,杭州310003 [3]同济大学附属同济医院检验科,上海200065

出　　处：《中华检验医学杂志》2023年第1期62-67,共6页Chinese Journal of Laboratory Medicine

基　　金：国家自然科学基金(82272396);上海市加强公共卫生体系建设三年行动计划(2020-2022年);中国博士后科学基金(2020M681399)。

摘　　要：目的分析戊型肝炎急性肝衰竭(HEV-ALF)患者血清氨甲酰磷酸合成酶1(CPS1)水平与患者预后的相关性,评估血清CPS1水平对HEV-ALF患者30 d病死率的预测价值。方法收集2018年12月至2019年6月浙江大学医学院附属第一医院等6家医院的100例HEV-ALF患者、100例急性戊型肝炎(AHE)患者以及100名健康人群3组资料进行回顾性分析。根据HEV-ALF患者30 d随访期内是否死亡,分为死亡(n=21)和生存(n=79)亚组;根据HEV-ALF患者血清CPS1的中位数水平,分为高CPS1水平(n=50)和低CPS1水平(n=50)亚组;根据HEV-ALF患者病情变化情况,分为病情好转(n=55)、病情波动(n=32)和病情恶化(n=13)亚组。收集所有纳入对象的一般资料。通过酶联免疫吸附试验检测血清CPS1水平。采用Kaplan-Meier曲线比较高CPS1水平和低CPS1水平患者的生存时间。通过线性回归分析血清CPS1水平与HEV-ALF患者丙氨酸转氨酶和总胆红素水平的相关性。用受试者工作特征曲线评价血清CPS1水平预测HEV-ALF患者30 d病死率的效能。结果HEV-ALF组血清CPS1水平高于AHE组[958.6(665.5,1105.8)pg/ml比549.4(495.0,649.1)pg/ml,P<0.001],AHE组血清CPS1水平高于健康人群[549.4(495.0,649.1)pg/ml比469.9(373.3,564.5)pg/ml,P<0.001]。HEV-ALF患者生存亚组的血清CPS1水平低于死亡亚组[922.6(652.7,1042.3)pg/ml比1252.8(933.3,1555.8)pg/ml,P<0.001],且高CPS1水平HEV-ALF患者的生存时间低于低CPS1水平患者[24.59(22.11,27.06)d比28.16(26.25,30.07)d,P=0.045]。与入院时CPS1水平比较,波动和恶化亚组血清CPS1水平升高,而好转亚组降低(P均<0.01)。此外,患者血清CPS1水平与丙氨酸转氨酶和总胆红素呈正相关(r=0.339、0.304,P均<0.01)。血清CPS1水平预测HEV-ALF患者30 d病死率的曲线下面积为0.803(95%CI 0.666~0.941),敏感度为66.67%,特异度为97.47%。结论血清CPS1水平在HEV-ALF患者中高表达,且与患者的预后密切相关。Objective To explore the impact of serum carbamoyl phosphate synthase 1(CPS1)level on prognosis of patients with hepatitis E-related acute liver failure(HEV-ALF).Methods This retrospective analysis included 100 HEV-ALF patients,100 patients with acute hepatitis E(AHE)and 100 healthy controls who admitted or underwent health checkup from December 2018 to June 2019 in six hospitals,including the First Affiliated Hospital,Zhejiang University School of Medicine.HEV-ALF patients were divided into non-survial(n=21)and survival(n=79)subgroups according to results of 30-day follow-up results.HEV-ALF patients were also divided into the high(n=50)and low(n=50)serum CPS1 level groups.HEV-ALF patients were further divided into the improvement(n=55),fluctuation(n=32)and deterioration(n=13)subgroups.The general clinical data from all participants were collected.Serum CPS1 levels were detected by enzyme linked immunosorbent assay.The survival time in the high and low serum CPS1 level groups were presented in the Kaplan-Meier curve.The correlation between serum CPS1 level and HEV-ALF related conventional parameters was also analyzed by linear regression.The efficacy of serum CPS1 level on predicting the 30-day mortality of HEV-ALF patients was estimated by the receiver operating characteristic curve and area under curve(AUC).Results Serum CPS1 level was significantly higher in HEV-ALF patients than in AHE patients[958.59(665.52,1105.83)pg/ml vs 549.38(495.02,649.08)pg/ml,P<0.001],and serum CPS1 level was significantly higher in AHE patients than in healthy controls[549.38(495.02,649.08)pg/ml vs 469.89(373.32,564.53)pg/ml,P<0.001].The level of serum CPS1 was significantly lower in the HEV-ALF survival group than in the HEV-ALF non-survival group[922.6(652.7,1,042.3)pg/ml vs 1252.8(933.3,1555.8)pg/ml,P<0.001].In addition,the survival time was shorter in the high serum CPS1 level group than in the low serum CPS1 level group[24.59(22.11,27.06)d vs 28.16(26.25,30.07)d,P=0.045].Serum CPS1 levels were increased in the fluctuation and d

关 键 词：戊型肝炎 急性肝衰竭 氨甲酰磷酸合成酶 预后 

分 类 号：R512.6[医药卫生—内科学] R575.3[医药卫生—临床医学]