血清sTFR联合Bikunin对HBV-ACLF患者近期预后的评估价值  

Assessment value of serum sTFR combined with Bikunin on the short-term prognosis of patients with hepatitis B virus related acute on chronic live failure

作　　者：陶丰宝 杨红园[1] 刘金凤 陈建红[3] TAO Fengbao;YANG Hongyuan;LIU Jinfeng;CHEN Jianhong(Department of Infectious Diseases,Weifang People's Hospital,Weifang,Shandong 261000,China;Department of Obstetrics and Gynecology,Weifang High-tech Zone People's Hospital,Weifang,Shandong 261071,China;Hepatobiliary and Pancreatic Medical Center,Weifang People's Hospital,Weifang,Shandong 261000,China)

机构地区：[1]潍坊市人民医院感染性疾病科,山东潍坊261000 [2]潍坊高新区人民医院妇产科,山东潍坊261071 [3]潍坊市人民医院肝胆胰医学中心,山东潍坊261000

出　　处：《国际检验医学杂志》2024年第21期2588-2593,2599,共7页International Journal of Laboratory Medicine

基　　金：山东省医药卫生计划项目(2020WS120)。

摘　　要：目的探讨血清可溶性转铁蛋白受体(sTFR)、尿胰蛋白酶抑制剂(Bikunin)对乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者近期预后的评估价值。方法收集2019年1月至2022年12月潍坊市人民医院收治的103例HBV-ACLF患者为HBV-ACLF组,根据疾病进展分为早期组(n=46)、中期组(n=34)、晚期组(n=23),根据患者入院后30 d临床结局分为预后良好组(n=67)和预后不良组(n=36),并收集同期65例慢性HBV感染患者作为慢性乙型肝炎组和65例健康志愿者作为对照组。收集各组研究对象入院时临床病历资料,采用酶联免疫吸附试验检测血清sTFR和Bikunin水平,Spearman秩相关分析血清sTFR、Bikunin与疾病进展的关系,多因素Logistic回归分析HBV-ACLF患者短期预后不良的影响因素,受试者工作特征(ROC)曲线评估血清sTFR、Bikunin对预后的预测价值。结果HBV-ACLF组、慢性乙型肝炎组血清sTFR、Bikunin水平低于对照组,且HBV-ACLF组低于慢性乙型肝炎组,差异有统计学意义(P<0.05)。HBV-ACLF组、慢性乙型肝炎组终末期肝病模型(MELD)评分高于对照组,且HBV-ACLF组高于慢性乙型肝炎组,差异有统计学意义(P<0.05)。与早期组比较,中期组和晚期组血清sTFR、Bikunin水平降低,且晚期组低于中期组,差异有统计学意义(P<0.05);中期组和晚期组MELD评分增加,且晚期组高于中期组,差异有统计学意义(P<0.05)。HBV-ACLF患者血清sTFR、Bikunin与MELD评分相关(r=-0.638、-0.592,P<0.05),与病情严重程度相关(r_(s)=-0.722、-0.671,P<0.05)。乙型肝炎病毒表面抗原升高、HBV DNA定量升高、HBVACLF中期和晚期、MELD评分升高是HBV-ACLF患者短期预后不良的独立危险因素(OR>1,P<0.05),血清sTFR和Bikunin升高是HBV-ACLF患者短期预后不良的保护因素(OR<1,P<0.05)。血清sTFR、Bikunin对短期预后不良均有一定预测价值,联合预测价值大于单一指标(Z=2.139、2.165,P<0.05)。结论HBVACLF患者血清sTFR、Bikunin降低,并与病�Objective To explore the value of serum soluble transferrin receptor(sTFR)and urinary trypsin inhibitor(Bikunin)in assessing the short-term prognosis of patients with hepatitis B virus related acute on chronic live failure(HBV-ACLF).Methods A total of 103 patients with HBV-ACLF admitted to Weifang People's Hospital from January 2019 to December 2022 were collected as HBV-ACLF group,who were classified into early stage group(n=46),middle stage group(n=34)and late stage group(n=23)according to the disease progression,and classified into good prognosis group(n=67)and poor prognosis group(n=36)according to clinical outcomes at 30 d after hospital admission.At the same time,65 patients with chronic hep-atitis B virus infection were selected as chronic hepatitis B group and 65 healthy volunteers were selected as control group were enrolled in the study.The clinical medical records of research objects were collected at the time of admission.Serum sTFR and Bikunin levels were detected by enzyme-linked immunosorbent assay.Spearman rank correlation analysis was performed to analyze the association between serum sTFR,Bikunin and disease progression.Multivariate Logistic regression analysis was performed to analyze factors affecting short-term poor prognosis of patients with HBV-ACLF.Receiver operating characteristic(ROC)curve was used to assess the predictive value of serum sTFR and Bikunin on prognosis.Results Serum sTFR and Bikun-in levels were lower in HBV-ACLF group and chronic hepatitis B group than those in control group,and those in HBV-ACLF group were lower than those in chronic hepatitis B group,and the differences were statistically significant(P<0.05).Model for End-Stage Liver Disease(MELD)score was higher in HBV-ACLF group and chronic hepatitis B group than that in control group,and that in HBV-ACLF group was higher than that in chronic hepatitis B group,and the differences were statistically significant(P<0.05).Compared with early stage group,serum sTFR and Bikunin levels decreased in middle stage group and lat

关 键 词：乙型肝炎病毒相关慢加急性肝衰竭 慢性乙型肝炎病毒 可溶性转铁蛋白受体 尿胰蛋白酶抑制剂 短期预后 

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