腺苷高半胱氨酸酶在戊型肝炎急性肝衰竭患者预后评估中的价值  

Prognostic value of serum adenosylhomocysteinase in patients with hepatitis E related acute liver failure

作　　者：严虹 向泽 陈佳琦 江春 李淑湘[4] 翟光华[4] 吴健[4] Yan Hong;Xiang Ze;Chen Jiaqi;Jiang Chun;Li Shuxiang;Zhai Guanghua;Wu Jian(Department of Clinical Laboratory,the Second Affliated Hospital,Nanjing Medical University,Nanjing 210011,China;State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases,National Clinical Research Center for Infectious Diseases,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Laboratory Medicine,Jiangsu University School of Medicine,Zhenjiang 212013,China;Department of Clinical Laboratory,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215008,China)

机构地区：[1]南京医科大学第二附属医院检验医学中心,南京210011 [2]浙江大学医学院附属第一医院传染病诊治国家重点实验室、国家感染性疾病临床医学研究中心、感染性疾病诊治协同创新中心,杭州310003 [3]江苏大学医学院检验系,镇江212013 [4]南京医科大学附属苏州医院检验科,苏州215008

出　　处：《中华检验医学杂志》2024年第8期888-894,共7页Chinese Journal of Laboratory Medicine

基　　金：国家自然科学基金(82272396);苏州市医疗卫生科技创新(指令性)新型临床诊疗科技及公共卫生项目(SKY2022057);济南微生态生物医学省实验室面上项目(JNL2023005C)。

摘　　要：目的探究血清腺苷高半胱氨酸酶(AHCY)在戊型肝炎急性肝衰竭(HEV-ALF)患者的预后价值。方法自2017年1月1日至2022年12月31日, 该病例对照研究收集HEV-ALF和急性戊型肝炎(AHE)患者各100例, 患者来自浙江大学医学院附属第一医院和南京医科大学附属苏州医院, HEV-ALF组年龄(58.56±11.16)岁, 男性71例。AHE组年龄(56.04±14.30)岁, 男性61例。所有血清样本均在患者急性发病且未治疗前取得。首先使用酶联免疫吸附方法分析HEV-ALF和AHE患者的血清AHCY水平。其次比较不同器官衰竭数量和病情变化情况HEV-ALF患者的血清AHCY水平, 根据器官衰竭数量将100例HEV-ALF患者分成器官衰竭2个组(n=58), 器官衰竭3个组(n=24)和器官衰竭>3 组(n=18), 根据病情变化情况将100例患者分为病情好转组(n=49), 病情波动组(n=37), 病情恶化组(n=14)。然后比较血清AHCY高水平组(n=50)和血清AHCY低水平组(n=50)的生存时间。最后采用多因素Logistic回归分析去探究预测HEV-ALF患者死亡的独立危险因素, 并采用受试者工作特征(ROC)曲线和决策曲线分析(DCA)评价血清AHCY水平的预测力和决策力。结果 HEV-ALF患者的血清AHCY水平[326.92(295.37, 385.84)pg/ml]高于AHE患者[222.88(188.04, 246.78)pg/ml], 差异有统计学意义, Z=-12.217, P<0.001。器官衰竭2个组的血清AHCY水平低于器官衰竭3个组的血清AHCY水平[303.44(284.40, 330.15)pg/ml比335.36(306.30, 385.84)pg/ml, Z=-3.353, P=0.001];器官衰竭3个组的血清AHCY水平低于器官衰竭>3个组的血清AHCY水平[335.36(306.30, 385.84)pg/ml比549.89(423.35, 660.22)pg/ml, Z=-4.016, P<0.001]。病情波动组的血清AHCY水平低于病情恶化组的血清AHCY水平[322.17(283.92, 423.74)pg/ml比458.26(374.66, 593.89)pg/ml, Z=-2.596, P=0.009]。高血清AHCY水平组的生存时间低于低血清AHCY水平组[23.11(20.25, 25.96)d比29.49(28.79, 30.20)d, P<0.001]。多因素Logistic回归分析表明血清AHCY水平和总胆红素水平�Objective:To investigate the prognostic value of serum adenosylhomocysteinase(AHCY)in patients with hepatitis E virus acute liver failure(HEV-ALF).Methods:From 1 January 2017 to 31 December 2022,100 patients each with HEV-ALF and acute hepatitis E(AHE)from the First Affiliated Hospital of Medical School of Zhejiang University and Affiliated Suzhou Hospital of Nanjing Medical University were included in this case-control study.The HEV-ALF group was 58.56±11.16 years old,including 71 men.The AHE group was 56.04±14.30 years old,including 61 men.All serum samples were obtained before the patient had an acute onset and were obtained without treatment.Firstly,the serum AHCY levels in patients with HEV-ALF and AHE were analyzed by ELISA.Secondly,the serum AHCY levels in HEV-ALF patients with different organ failure and disease condition were compared.According to the number of organ failure,100 HEV-ALF patients were divided into organ failure number=2 group(n=58),number=3 group(n=24)and number>3 groups(n=18).According to the disease condition,100 patients were divided into improvement group(n=49),disease fluctuation group(n=37),and deterioration group(n=14).Thirdly,the survival times between the high serum AHCY level group(n=50)and the low serum AHCY level group(n=50)were compared.Finally,the independent risk factors to predict mortality using the multivariate Logistic regression analysis,and evaluated the predictive and decision-making abilities of serum AHCY levels were explored using the receiver operating characteristic(ROC)curve and decision curve analysis(DCA).Results:Serum AHCY levels in HEV-ALF patients were significantly higher than those in AHE patients[326.92(295.37-385.84)pg/ml vs.222.88(188.04-246.78)pg/ml,Z=-12.217,P<0.001].Serum AHCY levels in group 2 were significantly lower than those in group 3[303.44(284.40-330.15)pg/ml vs.335.36(306.30-385.84)pg/ml,Z=-3.353,P=0.001].Serum AHCY level in group 3 were significantly lowerthan those in group>3[335.36(306.30-385.84)pg/ml vs.549.89(423.35-660.22)pg/ml,P<0

关 键 词：肝炎 戊型 肝功能衰竭 急性 腺苷高半胱氨酸酶 预后 决策曲线分析 

分 类 号：R575.3[医药卫生—消化系统] R512.6[医药卫生—内科学]