血清Dnase1L3、CAR联合MHR对失代偿期乙型肝炎肝硬化患者预后的评估价值  

The prognostic value of serum Dnase1L3,CAR combined with MHR in decompensated hepatitis B cirrhosis patients

作　　者：武云慧[1] 董敬超 苗亮[2] 张继东[1] Wu Yunhui;Dong Jingchao;Miao Liang;Zhang Jidong(Department of Clinical Laboratory,The Third Hospital of Qinhuangdao,Qinhuangdao 066000,China;Department of Hepatology,The Third Hospital of Qinhuangdao,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第三医院检验科,秦皇岛066000 [2]秦皇岛市第三医院肝病科,秦皇岛066000

出　　处：《中国医师杂志》2024年第1期76-81,86,共7页Journal of Chinese Physician

基　　金：河北省医学科学研究课题计划(20201311);秦皇岛市级科学技术研究与发展计划项目(202005A023)。

摘　　要：目的探讨血清脱氧核糖核酸酶1样蛋白3(Dnase1L3)、C反应蛋白/白蛋白比值(CAR)联合单核细胞与高密度脂蛋白胆固醇比值(MHR)对失代偿期乙型肝炎肝硬化患者预后的评估价值。方法前瞻性选择2020年1月至2021年12月秦皇岛市第三医院收治的236例失代偿期乙型肝炎肝硬化患者(肝病组)和185例门诊体检的健康志愿者(对照组)。检测两组血清Dnase1L3、CAR、MHR水平以及肝功能,Pearson分析Dnase1L3、CAR、MHR与肝功能的相关性。追踪患者住院30 d存活情况,多因素logistic回归方程分析影响失代偿期乙型肝炎肝硬化患者住院30 d死亡的危险因素,受试者工作特征(ROC)曲线分析Dnase1L3、CAR、MHR预测失代偿期乙型肝炎肝硬化患者院内30 d死亡的价值。结果肝病组血清Dnase1L3、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBiL)水平及CAR、MHR高于对照组(均P<0.05),肝病组血清Dnase1L3、CAR、MHR与AST、ALT、TBiL均呈正相关(均P<0.05)。236例患者30 d内死亡32例,终末期肝病模型(MELD)评分>18分、高Dnase1L3、高CAR、高MHR是失代偿期乙型肝炎肝硬化患者住院30 d死亡的危险因素(均P<0.05)。Dnase1L3、CAR、MHR和MELD评分联合预测失代偿期乙型肝炎肝硬化患者住院30 d死亡的曲线下面积为0.904,高于单独指标预测的0.719、0.678、0.763、0.742。结论失代偿期乙型肝炎肝硬化患者血清Dnase1L3水平及CAR、MHR增高,且与肝功能损伤程度以及住院30 d内死亡相关,在失代偿期乙型肝炎肝硬化预后预测中具有较高价值。Objective To explore the prognostic value of serum deoxyribonuclease 1 like 3(Dnase1L3),C-reactive protein/albumin ratio(CAR)combined with monocyte to high-density lipoprotein cholesterol ratio(MHR)in decompensated hepatitis B cirrhosis patients.Methods A prospective selection was conducted on 236 decompensated hepatitis B cirrhosis patients(liver disease group)admitted to the Third Hospital of Qinhuangdao from January 2020 to December 2021,and 185 healthy volunteers(control group)who underwent outpatient physical examinations.The serum levels of Dnase1L3,CAR,MHR,and liver function were detected,and Pearson analysis was conducted to investigate the correlation between Dnase1L3,CAR,MHR,and liver function.Tracking the survival status of patients after 30 days of hospitalization,the risk factors affecting 30 day mortality in decompensated hepatitis B cirrhosis patients were analyzed using a multivariate logistic regression equation.The receiver operating characteristic(ROC)curve analysis was used to assess the value of Dnase1L3,CAR,and MHR in predicting 30 day in-hospital mortality in decompensated hepatitis B cirrhosis patients.Results The serum levels of Dnase1L3,alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBiL),CAR,and MHR in the liver disease group were higher than those in the control group(all P<0.05).The serum levels of Dnase1L3,CAR,and MHR in the liver disease group were positively correlated with AST,ALT,and TBiL(all P<0.05).Among 236 patients,32 died within 30 days.Model for end-stage liver disease(MELD)scores>18,high Dnase1L3,high CAR,and high MHR were risk factors for 30 day mortality in decompensated hepatitis B cirrhosis patients(all P<0.05).The combined prediction of Dnase1L3,CAR,MHR,and MELD scores for 30 day mortality in decompensated patients with hepatitis B cirrhosis showed an area under the curve of 0.904,which was higher than the predicted values of 0.719,0.678,0.763,and 0.742 for individual indicators.Conclusions The serum Dnase1L3 levels,CAR,and MHR are eleva

关 键 词：乙型肝炎 肝硬化 DNASE1L3蛋白 C反应蛋白质 血清白蛋白 单核细胞 胆固醇 HDL 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]