血清色氨酸用于乙肝相关慢加急性肝衰竭90 d死亡风险分层管理的潜在价值:一项多中心回顾性研究  

Value of serum tryptophan in stratified management of 90-day mortality risk in patientswith hepatitis B virus-related acute-on-chronic liver failure: a multicenter retrospectivestudy

作　　者：周超 张晶晶 唐巧 付双楠 张宁 何召云 张瑾 张田义 刘鹏程 宫嫚 ZHOU Chao;ZHANG Jingjing;TANG Qiao;FU Shuangnan;ZHANG Ning;HE Zhaoyun;ZHANG Jin;ZHANG Tianyi;LIU Pengcheng;GONG Man(Department of Traditional Chinese Medicine Liver Diseases,Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China;College of Traditional Chinese Medicine,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]中国人民解放军总医院第五医学中心中医肝病科,北京100039 [2]南方医科大学中医药学院,广东广州510515

出　　处：《南方医科大学学报》2025年第1期59-64,共6页Journal of Southern Medical University

基　　金：国家科技重大专项项目(2018ZX10725506-002);国家自然科学基金(82305067)。

摘　　要：目的探索血清色氨酸与乙肝相关慢加急性肝衰竭(HBV-ACLF)死亡风险之间的相关性。方法回顾性纳入180例HBVACLF患者,根据确诊后90 d结局为患者分为存活组和死亡组;采用高效液相色谱法测定两组患者外周血中的血清色氨酸含量;比较两组患者基线血清色氨酸水平的差异;通过单因素及多因素回归分析基线血清色氨酸水平对于HBV-ACLF患者确诊后90 d病死率的影响;通过受试者曲线下面积探讨血清色氨酸对HBV-ACLF 90 d死亡风险的潜在预测价值。结果90 d随访期内,53例(29.4%)HBV-ACLF患者因疾病死亡,127例(70.6%)存活。死亡患者的基线色氨酸水平低于存活患者(P<0.001);经多因素回归分析校正混杂因素显示,色氨酸水平是HBV-ACLF死亡风险的独立预测因素。HBV-ACLF患者入组时低水平色氨酸(<10.14 pg/mL)与高水平色氨酸(≥10.14 pg/mL)相比具有更高的90 d死亡风险(43.3%vs 15.6%,HR:3.157,95%CI:1.713-5.817);同时合并肾功能不全和低水平色氨酸的90 d死亡风险更高(73.3%vs 15.0%,HR:7.558,95%CI:3.369-16.960);血清色氨酸水平用于预测HBV-ACLF患者的90 d死亡风险具有一定潜在价值(ROC=0.771,95%CI:0.699-0.844)。结论血清色氨酸与HBV-ACLF预后密切相关;低水平的血清色氨酸预示90 d高死亡风险;尤其是同时合并肾功能不全的患者90 d死亡风险更高。Objective To explore the correlation of serum tryptophan level with 90-day mortality risk in patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods This retrospective study was conducted among 108 patients with HBV-ACLF,whose survival outcomes within 90 days after diagnosis were recorded.The correlation of baseline serum tryptophan levels measured by high-performance liquid chromatography with 90-day mortality of the patients was analyzed,and the predictive value of serum tryptophan for 90-day mortality was explored.Results Within 90 days after diagnosis,53(29.4%)of the patients died and 127(70.6%)survived.The deceased patients had significantly lower baseline serum tryptophan levels than the survivors(7.31±3.73 pg/mL vs 13.32±7.15 pg/mL,P<0.001).Multivariate analysis suggested that serum tryptophan level was an independent factor correlated with mortality of HBV-ACLF after adjustment for confounding variables.The patients with serum tryptophan levels below the median level(10.14 pg/mL)at admission had significantly higher 90-day mortality risks than those with higher tryptophan levels(43.3%vs 15.6%,HR:3.157,95%CI:1.713-5.817),and the complication by kidney dysfunction further increased the risk to 73.3%as compared with patients with higher serum tryptophan levels with normal kidney function(15.0%;HR:7.558,95%CI:3.369-16.960).Serum tryptophan levels had an area under the receiver operating characteristic curve of 0.771(95%CI:0.699-0.844)for predicting 90-day mortality.Conclusion Serum tryptophan level is closely correlated with the survival outcomes of patients with HBV-ACLF,and a decreased tryptophan level indicates a high 90-day mortality risk,which can be further increased by the complication by kidney dysfunction.

关 键 词：肝衰竭 预后 色氨酸 乙型肝炎病毒 肾功能不全 

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