慢加急性肝衰竭患者血清Clusterin和CCR5表达水平及其对预后预测价值研究  

Predictive Value of Combined Detection of Serum Clusterin and CCR5 Levels for Prognosis of Patients with Acute-on-Chronic Liver Failure

作　　者：阎冬梅[1] 庞文艳 赵莲蕊 YAN Dong-mei;PANG Wen-yan;ZHAO Lian-rui(Tangshan Infectious Diseases Hospital,Hebei Tangshan 063000,China;Tangshan Central Hospital,Hebei Tangshan 063000,China)

机构地区：[1]唐山市传染病医院,河北唐山063000 [2]唐山市中心医院,河北唐山063000

出　　处：《现代检验医学杂志》2023年第3期134-137,183,共5页Journal of Modern Laboratory Medicine

基　　金：2020年河北省医学科学研究课题计划项目(编号:20201438):人工肝血浆置换治疗肝衰竭的疗效及成本效果分析。

摘　　要：目的探讨血清丛生蛋白(Clusterin)及趋化因子受体5(CCR5)在慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)患者中的表达以及两者联合检测对ACLF患者预后的预测价值。方法选取2018年1月~2020年12月唐山市传染病医院收治的84例ACLF患者作为观察组,同期选择在该院体检的80例健康体检者作为对照组。采用酶联免疫吸附试验(ELISA)法测定患者血清中Clusterin和CCR5水平;根据患者预后28天情况,将其分为存活组(n=48)和死亡组(n=36)。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析血清Clusterin与CCR5联合检测对ACLF患者预后的预测价值;Spearman相关性分析血清Clusterin和CCR5水平与终末期肝病模型(model for end-stage liver disease,MELD)评分、慢性肝衰竭-序贯器官衰竭评分(chronic liver failure-sequential organ failure assessment,CLIF-SOFA)的相关性;采用多因素Logistic回归分析ACLF患者预后的影响因素。结果与对照组相比,观察组Clusterin(87.37±9.99μg/ml vs 104.85±15.14μg/ml)及CCR5(11.55±2.86μg/ml vs 15.68±3.01μg/ml)水平降低,差异具有统计学意义(t=8.767,9.010,均P<0.05)。与存活组相比,死亡组Clusterin(77.40±9.26μg/ml vs94.85±10.54μg/ml)及CCR5(8.58±1.98μg/ml vs 13.78±3.52μg/ml)水平降低,差异具有统计学意义(t=7.904,7.962,均P<0.05)。ROC曲线显示,血清Clusterin与CCR5联合预测的曲线下面积(area under curve,AUC)(0.927)最大,其敏感度和特异度分别为88.90%和83.30%。经Spearman相关性分析Clusterin与MELD,CLIF-SOFA评分呈负相关(r=-0.524,-0.457,均P<0.05),CCR5与MELD,CLIF-SOFA评分呈负相关(r=-0.611,-0.358,均P<0.05)。多因素Logistic回归分析显示,血清Clusterin,CCR5及IL-6为ACLF患者预后不良的影响因素(均P<0.05)。结论Clusterin及CCR5在ACLF患者血清中表达下调,且联合检测二者在预测ACLF患者短期预后方面具有良好的参考价值。Objective To investigate the expression levels of serum Clusterin and C-C chemokine receptor 5(CCR5)in patients with acute-on-chronic liver failure(ACLF)and the predictive value of their combined detection for the prognosis of ACLF patients.Methods A total of 84 ACLF patients admitted to Tangshan Infectious Disease Hospital from January 2018 to December 2020 were taken as the observation group,and 80 healthy subjects in the hospital were taken as the control group.The levels of Clusterin and CCR5 in serum of patients were determined by enzyme-linked immunosorbent assay(ELISA).According to the 28-day prognosis of patients,they were grouped into a survival group(n=48)and a death group(n=36).Receiver operating characteristic(ROC)curve was applied to analyze the predictive value of serum Clusterin and CCR5 combined detection on the prognosis of ACLF patients.Spearman correlation was applied to analyze the correlation between serum Clusterin and CCR5 levels,model of end-stage liver disease(MELD)score and chronic liver failure-sequential organ failure assessment(CLIF-SOFA)score.Multivariate Logistic regression was applied to analyze the prognostic factors of ACLF patients.Results Compared with the control group,the levels of Clusterin(87.37±9.99μg/ml vs 104.85±15.14μg/ml)and CCR5(11.55±2.86μg/ml vs15.68±3.01μg/ml)in the observation group were lower,and the differences were statistically significant(t=8.767,9.010,all P<0.05).Compared with the survival group,the Clusterin(77.40±9.26μg/ml vs 94.85±10.54μg/ml)and CCR5(8.58±1.98μg/ml vs 13.78±3.52μg/ml)levels in the death group were lower(t=7.904,7.962,all P<0.05).The ROC curve showed that the area under the curve(0.927)of the combined prediction of serum Clusterin and CCR5 was the largest,and the sensitivity and specificity were 88.90%and 83.30%,respectively.The Spearman correlation analysis showed that Clusterin was negatively correlated with MELD and CLIF-SOFA scores(r=-0.524,-0.457,all P<0.05),and CCR5 was negatively correlated with MELD and CLIF-SOFA sc

关 键 词：丛生蛋白 趋化因子受体5 慢加急性肝衰竭 

分 类 号：R575.3[医药卫生—消化系统] R392.11[医药卫生—内科学]