甲胎蛋白和肝细胞生长因子表达水平评估乙肝相关慢加急性肝衰竭患者预后的价值  

The value of alpha fetoprotein and hepatocyte growth factor in evaluating the prognosis of patients with hepatitis B related chronic acute liver failure

作　　者：巴哈尔古丽·罗克满江[1] 曾钰 吴雪[1] 肖红[3] BAHAERGULI Luokemanjiang;ZENG Yu;WU Xue;XIAO Hong(Infection Department of the Fifth Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 83001l,China;Internal Medicine Department of Chengdu Chengnan Jinhua Hospital,Chengdu,Sichuan 610041,China;Image Center of the Fifth Affiliated Hospital of Xinjiang Medical University,Urumgi,Xinjiang 830011,China)

机构地区：[1]新疆医科大学第五附属医院感染科,新疆乌鲁木齐830011 [2]成都城南金花医院内科,四川成都610041 [3]新疆医科大学第五附属医院影像中心,新疆乌鲁木齐830011

出　　处：《热带医学杂志》2024年第6期829-833,共5页Journal of Tropical Medicine

基　　金：新疆维吾尔自治区自然科学基金项目(2018D01C312)。

摘　　要：目的 通过检测乙肝相关慢加急性肝衰竭患者血清甲胎蛋白和肝细胞生长因子(HGF)表达水平,探讨两者在评估此类患者治疗效果和预后的价值,旨在为指导临床决策以改善患者预后提供依据。方法 纳入2020年1月-2021年12月在新疆医科大学第五附属医院感染科就诊的106例乙肝相关慢加急性肝衰竭患者作为研究对象,按出院治疗效果分为预后良好组(n=21)和预后不良组(n=85)。比较两组血清乙肝DNA、白蛋白、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素、肌酐、凝血酶原活动度(PTA)、甲胎蛋白及HGF水平;采用多因素logistic回归分析获得影响乙肝相关慢加急性肝衰竭患者治疗预后的独立预测因素;受试者工作特征(ROC)曲线分析甲胎蛋白和HGF预测乙肝相关慢加急性肝衰竭患者治疗预后的价值;以甲胎蛋白和HGF预测乙肝相关慢加急性肝衰竭患者治疗预后的净受益率为纵坐标,高风险阈值为横坐标,绘制决策曲线,分析两者以及联合预测模型预测乙肝相关慢加急性肝衰竭患者治疗预后的净收益情况。结果 预后不良组患者乙肝DNA、总胆红素、肌酐分别为(7.3±1.3)×106 copies/mL、(187.4±23.3)μmol/L、(178.4±35.3)μmol/L,明显高于预后良好组的(4.2±1.1)×106copies/mL、(167.2±22.4)μmol/L、(142.5±32.6)μmol/L;PTA、甲胎蛋白、HGF分别为(23.2±3.1)%、(86.2±13.9)ng/mL、(183.7±28.9)ng/L,明显低于预后良好组(28.6±3.2)%、(132.3±25.8)ng/mL、(243.5±31.6)ng/L;以上差异均有统计学意义(t=3.789、2.018、4.567、2.567、6.712、7.876,P均<0.05);两组患者AST、ALT以及白蛋白比较差异均无统计学意义(P均>0.05)。多因素logistic回归分析结果显示,甲胎蛋白、HGF为影响乙肝相关慢加急性肝衰竭患者治疗预后的独立预测因素(P均<0.05)。ROC分析结果显示,甲胎蛋白预测乙肝相关慢加急性肝衰竭患者治疗预后的曲线下面积(AUC)为0.803(95%CI:Objectives To investigate the value of alpha fetoprotein and hepatocyte growth factor(HGF) in evaluating the prognosis of patients with hepatitis B related chronic acute liver failure. To investigate their value in evaluating the treatment efficacy and prognosis of such patients which was aimed at providing a basis for guiding clinical decision-making to improve patient prognosis. Methods A total of 106 patients with hepatitis B related chronic acute liver failure who were treated in the Infection Department of the Fifth Affiliated Hospital of Xinjiang Medical University from January 2020 to December 2021were selected as the research objects. According to the admission treatment effect, they were divided into good prognosis group(n=21) and poor prognosis group(n=85). The serum levels of hepatitis B DNA, albumin, alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin, creatinine, prothrombin activity(PTA), alpha fetoprotein and HGF were compared between the two groups. Prognosis of hepatitis B related chronic hepatitis patients with acute liver failure were independently predicted by multivariate logistic regression analysis. The receiver operating characteristic(ROC) curve of AFP and HGF predicting the prognosis of hepatitis B related chronic acute liver failure was performed. The net benefit rate of the prognosis hepatitis B related acute on chronic liver failure patients was predicted by AFP and HGF as the ordinate, and the high-risk threshold was abscissa, and the decision curve was drawn. Analyze both and joint prediction model to predict the net benefit rate of the prognosis of hepatitis B related chronic acute liver failure patients. Results Hepatitis B DNA, total bilirubin and creatinine in the poor prognosis group were(7.3±1.3)×106 copies/mL,(187.4±23.3)μmol/L and(178.4±35.3)μmol/L, which were significantly higher than those in the good prognosis group [(4.2±1.1)×106 copies/mL,(167.2±22.4)μmol/L,(142.5±32.6)μmol/L];PTA, alpha fetoprotein and HGF in the poor prognosis g

关 键 词：甲胎蛋白 肝细胞生长因子 乙肝相关慢加急性肝衰竭 

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