非生物型人工肝治疗前后细胞因子水平变化对慢加急性肝衰竭治疗时机选择及其短期疗效的预测  

A study on treatment timing selection and short-term efficacy prediction with changes in cytokine levels before and after non-biological artificial liver treatment in acute-on-chronic liver failure

作　　者：安薪宇 胡灵溪 李妹 刘百成 王荣琦[1] 南月敏[1] An Xinyu;Hu Lingxi;Li Mei;Liu Baicheng;Wang Rongqi;Nan Yuemin(Department of Traditional and Western Medical Hepatology,Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院中西医结合肝病科,石家庄050051

出　　处：《中华肝脏病杂志》2022年第11期1218-1224,共7页Chinese Journal of Hepatology

基　　金：北京肝胆相照公益基金会2021年度人工肝专项基金(RGGJJ-2021-011)。

摘　　要：目的分析慢加急性肝衰竭(ACLF)患者非生物型人工肝(简称人工肝)治疗的疗效及其治疗前后细胞因子水平变化,探讨细胞因子水平在ACLF患者短期(28 d)预后中的诊断效能并为人工肝治疗时机的选择提供依据。方法选择诊断为ACLF患者90例,分为接受人工肝治疗组(45例)与未接受人工肝治疗组(45例),收集2组患者的年龄、性别、入院后第1次血常规、肝肾功能、降钙素原(PCT),追踪2组患者28 d生存情况,进行生存分析;接受人工肝治疗的45例患者根据出院前临床表现及最后一次实验室检查结果作为疗效判断指标,进一步分为好转组(24例)与恶化组(21例),收集患者第1次人工肝治疗前后血常规、凝血功能、肝肾功能、PCT、甲胎蛋白(AFP)、人β防御素-1(HBD-1)、12项细胞因子等指标,进行分析和比较;确定影响ACLF患者预后的独立危险因素,采用受试者操作特征曲线(ROC曲线)分析其对患者短期(28 d)预后的诊断效能。据资料不同用Kaplan-Meier法、log-rant检验、t检验、Wilcoxon秩和检验、Mann-Whitney U秩和检验、χ^(2)检验、Spearman秩相关分析、logistic回归分析进行统计学分析。结果接受人工肝治疗的ACLF患者28 d生存率明显高于未接受人工肝治疗组(82.2%对比61.0%,P<0.05)。经人工肝治疗后,ACLF患者的血清HBD-1、α干扰素(IFN-α)和白细胞介素-5(IL-5)水平较治疗前明显下降(P<0.05),肝功能及凝血功能较治疗前明显改善(P<0.05);其余血清学指标治疗前后差异无统计学意义(P>0.05)。人工肝治疗前,ACLF好转组患者血清HBD-1和INF-α水平明显低于恶化组(P<0.05),与患者预后(恶化)呈正相关(r值分别为0.591、0.427,P值分别为<0.001、0.008);ACLF好转组AFP水平明显高于恶化组(P<0.05),与患者预后(恶化)呈负相关(r=-0.557,P<0.001)。单因素logistic回归分析提示:HBD-1、IFN-α和AFP为ACLF患者预后的独立危险因素(P值分别为0.001、0.043、0.036),HBD-1、IFNObjective To investigate the efficacy and diagnostic accuracy of changes in cytokine levels before and after non-biological artificial liver(referred to as ABL)treatment in patients with acute-on-chronic liver failure(ACLF)in order to establish a basis for treatment timing selection and short-term(28d)prognosis.Methods 90 cases diagnosed with ACLF were selected and divided into a group receiving artificial liver treatment(45 cases)and a group not receiving artificial liver treatment(45 cases).Age,gender,first routine blood test after admission,liver and kidney function,and procalcitonin(PCT)of the two groups were collected.The 28-day survival of the two groups was followed-up for survival analysis.The 45 cases who received artificial liver therapy were further divided into an improvement group and a deterioration group according to the clinical manifestations before discharge and the last laboratory examination results as the efficacy evaluation indicators.Routine blood test,coagulation function,liver and kidney function,PCT,alpha fetoprotein(AFP),β-defensin-1(HBD-1),12 cytokines and other indicators were analyzed and compared.A receiver operating characteristic curve(ROC curve)was used to analyze the diagnostic efficacy of the short-term(28 d)prognosis and an independent risk factors affecting the prognosis of ACLF patients.According to different data,Kaplan-Meier method,log-rant test,t-test,Mann-Whitney U test,Wilcoxon rank-sum test,χ^(2)test,Spearman rank correlation analysis and logistic regression analysis were used for statistical analysis.Results The 28-day survival rate was significantly higher in ACLF patients who received artificial liver therapy than that of those who did not receive artificial liver therapy(82.2%vs.61.0%,P<0.05).The levels of serum HBD-1,alpha interferon(IFN-α)and interleukin-5(IL-5)after artificial liver treatment were significantly lower in ACLF patients than those before treatment(P<0.05),while liver and coagulation function were significantly improved compared with those before

关 键 词：慢加急性肝衰竭 非生物型人工肝 诊断 治疗时机 预后 

分 类 号：R575.3[医药卫生—消化系统]