HBV相关慢加急性肝衰竭患者血清GP73、suPAR和AT-Ⅲ水平变化及其临床意义探讨  

Prediction of short-term survival by serum GP73,suPAR and AT-III levels in patients with HBV-related acute-on-chronic liver failure

作　　者：李菲 陈辛未 李琦[2] Li Fei;Chen Xinwei;Li Qi(Department of Blood Transfusion,First Affiliated Hospital,Hebei North University,Zhangjiakou 075000,Hebei Province,China)

机构地区：[1]河北北方学院附属第一医院输血科,河北省张家口市075000 [2]河北北方学院附属第一医院血液病科,河北省张家口市075000

出　　处：《实用肝脏病杂志》2023年第6期847-850,共4页Journal of Practical Hepatology

基　　金：河北省科技厅医学科学研究项目(编号:20200505)。

摘　　要：目的探讨乙型肝炎病毒相关性慢加急性肝衰竭(HBV-ACLF)患者血清高尔基体蛋白73(GP73)、可溶性人尿激酶型纤溶酶原激活物受体(suPAR)和抗凝血酶-Ⅲ(AT-Ⅲ)水平变化及其临床意义。方法2019年11月~2022年10月我院收治的HBV-ACLF患者81例(早期29例,中期28例,晚期24例)和慢性乙型肝炎(CHB)患者65例,采用ELISA法检测血清GP73、suPAR和AT-Ⅲ水平。应用受试者工作特征曲线(ROC)评估各指标评估疾病预后的价值。结果HBV-ACLF患者血清GP73和suPAR水平分别为(227.4±48.4)ng/mL和(8.3±2.3)ng/mL,显著高于CHB患者【分别为(126.6±31.6)ng/mL和(5.1±1.6)ng/mL,P<0.05】,而血清AT-Ⅲ水平为(48.2±12.9)%,显著低于CHB患者【(76.6±18.7)%,P<0.05】;晚期HBV-ACLF患者血清GP73和suPAR水平分别为(265.6±27.1)ng/mL和(9.4±1.2)n g/mL,显著高于中期患者【分别为(231.7±29.5)ng/mL和(8.4±1.4)ng/mL,P<0.05】或早期患者【分别为(191.6±33.5)ng/mL和(7.3±1.6)ng/mL,P<0.05】,而血清AT-Ⅲ水平为(36.8±9.1)%,显著低于中期患者【(47.1±10.9)%,P<0.05】或早期患者【58.7±11.3)%,P<0.05】;在治疗3个月末,本组ACLF患者生存59例(72.8%),死亡22例(27.2%);死亡组血清GP73和suPAR水平分别为(270.4±38.3)ng/mL和(9.9±6.2)ng/mL,显著高于生存组【分别为(210.9±41.5)ng/mL和(8.0±1.5)ng/mL,P<0.05】,而血清AT-Ⅲ水平为(35.4±9.1)%,显著低于生存组【(51.1±10.6)%,P<0.05】;联合检测HBV-ACLF患者血清GP73、suPAR和AT-Ⅲ水平预测短期死亡的AUC为0.846,显著优于三项指标单独评估(其AUC分别为0.703、0.710和0.744,P<0.05),其灵敏度、特异度和准确度分别为81.8%、81.4%和81.5%。结论监测HBV-ACLF患者血清GP73、suPAR和AT-Ⅲ水平可能有助于评估预后,值得进一步研究。Objective The aim of this study was to explore the changes of Golgi protein 73(GP73),soluble urokinase plasminogen activator receptor(suPAR)and antithrombin-III(AT-III)levels in patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods 81 patients with HBV-ACLF,including 29 cases at early stage,28 cases at middle stage and 24 cases at advanced stage,and 65 patients with chronic hepatitis B(CHB),matched by gender and age,were enrolled in our hospital between November 2019 and October 2022.Serum GP73,suPAR and AT-III levels were detected by ELISA.The patients with HBV-ACLF were carefully managed and followed-up for 3 months.The predicting performance was evaluated by the area under the receiver operating characteristic(ROC)curves.Results Serum GP73 and suPAR levels in patients with HBV-ACLF were(227.4±48.4)ng/mL and(8.3±2.3)ng/mL,much higher than[(126.6±31.6)ng/mL and(5.1±1.6)ng/mL,respectively,P<0.05],while serum AT-Ⅲlevel was(48.2±12.9)%,much lower than[(76.6±18.7)%,P<0.05]in patients with CHB;serum GP73 and suPAR levels in patients with advanced HBV-ACLF were(265.6±27.1)ng/mL and(9.4±1.2)ng/mL,significantly higher than[(231.7±29.5)ng/mL and(8.4±1.4)ng/mL,P<0.05]in patients at middle stage or[(191.6±33.5)ng/mL and(7.3±1.6)ng/mL,P<0.05]in patients at early stage,while serum AT-Ⅲlevel was(36.8±9.1)%,significantly lower than[(47.1±10.9)%,P<0.05]in patients at middle stage or[58.7±11.3)%,P<0.05]in patients at early stage;at the end of three month treatment,59 patients(72.8%)survived and 22 patients(27.2%)died in our series;serum GP73 and suPAR levels in dead patients at admission were(270.4±38.3)ng/mL and(9.9±6.2)ng/mL,significantly higher than[(210.9±41.5)ng/mL and(8.0±1.5)ng/mL,P<0.05],while serum AT-Ⅲlevel was(35.4±9.1)%,significantly lower than[(51.1±10.6)%,P<0.05]in survivals;the AUC was 0.846 by the three combination in predicting the prognosis,much superior to the three parameters alone(the AUCs were 0.703,0.710 and 0.744,P<0.05),with the sensitivity of

关 键 词：慢加急性肝衰竭 高尔基体蛋白73 可溶性人尿激酶型纤溶酶原激活物受体 抗凝血酶-Ⅲ 预后 

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