慢加急性乙型肝炎肝衰竭患者血清sST2、TLR4、suPAR和Beclin1水平变化及其临床意义探讨  

Changes of serum sST2,TLR4,suPAR and Beclin1 levels in patients with HBV-related acute-on-chronic liver failure

作　　者：郭建晖 周永兵[2] 何钦 Guo Jianhui;Zhou Yongbing;He Qin(Clinical Laboratory,People's Hospital,Haimen District,Nantong226100,Jiangsu Province,China)

机构地区：[1]江苏省南通市海门区人民医院检验科,226100 [2]江苏大学附属人民医院/镇江巿第一人民医院检验科

出　　处：《实用肝脏病杂志》2025年第2期230-233,共4页Journal of Practical Hepatology

基　　金：江苏省卫生健康委医学科研项目(编号:Z2019025)。

摘　　要：目的探讨乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者血清可溶性生长刺激表达基因2(sST2)、Toll样受体4(TLR4)、可溶性人尿激酶型纤溶酶原激活物受体(suPAR)和自噬相关蛋白Beclin1水平变化及其临床意义。方法2019年11月~2023年11月我院收治的122例HBV-ACLF患者,常规给予内科综合治疗,记录90 d生存率。采用ELISA法检测血清sST2、TLR4、suPAR和Beclin1水平,绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),评估血清指标预测HBV-ACLF患者预后的效能。结果本组122例HBV-ACLF患者90 d生存64例(52.5%),死亡58例(47.5%);死亡组基线血清TBIL、INR和终末期肝病模型(MELD)评分分别为(342.3±97.4)μmol/L、(2.8±0.7)和23.4(19.3,27.3)分,均显著高于生存组【分别为(223.6±63.7)μmol/L、(1.7±0.5)和18.6(16.2,21.8)分,P<0.05】;死亡组基线血清sST2、TLR4、suPAR和Beclin1水平分别为(102.6±18.5)ng/mL、(38.7±7.2)pg/mL、(11.4±3.2)ng/mL和(13.4±2.6)mg/L,均显著高于生存组【分别为(74.8±13.4)ng/mL、(28.4±5.7)pg/mL、(7.2±1.9)ng/mL和(8.6±2.3)mg/L,P<0.05】;ROC曲线分析显示,以血清sST2、TLR4、suPAR和Beclin1水平任三个指标达到预测截断点,联合预测HBV-ACLF患者死亡的AUC为0.908,其灵敏度和特异度分别为70.8%和89.1%,预测效能较高(P<0.05)。结论监测血清sST2、TLR4、suPAR和Beclin1水平可能有助于评估HBV-ACLF患者预后,值得临床进一步观察和研究。Objective The aim of this study was to investigate the changes of serum soluble growth stimulating expression gene 2(sST2),Toll-like receptor 4(TLR4),soluble urokinase plasminogen activator receptor(suPAR)and Beclin 1 levels in patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods 122 patients with HBV-ACLF were enrolled in our hospital between November 2019 and November 2023,all received conventional liver-supporting therapy and followed-up for 3 months.Serum sST2,TLR4,suPAR and Beclin1 levels were detected by ELISA,and receiver operating characteristic curve(ROC)was drawn to evaluate predicting efficacy of serum indicators in patients with HBV-ACLF.Results 90 d survival rate in our series was 52.5%,as 58 patients didn’t survived;total serum bilirubin,INR and score of model for end-stage liver disease at presentation in dead patients were(342.3±97.4)μmol/L,(2.8±0.7)and 23.4(19.3,27.3),all significantly higher than[(223.6±63.7)μmol/L,(1.7±0.5)and 18.6(16.2,21.8),respectively,P<0.05]in survivals;serum sST2,TLR4,suPAR and Beclin1 levels were(102.6±18.5)ng/mL,(38.7±7.2)pg/mL,(11.4±3.2)ng/mL and(13.4±2.6)mg/L,all significantly higher than[(74.8±13.4)ng/mL,(28.4±5.7)pg/mL,(7.2±1.9)ng/mL and(8.6±2.3)mg/L,respectively,P<0.05]in survivals;ROC analysis showed that the AUC was 0.908,with sensitivity of 70.8%and specificity of 89.1%,suggesting a satisfactory predicting performance,when any three of the four serum parameters reached to cut-off-value in patients with HBV-ACLF.Conclusion Monitoring serum sST2,TLR4,suPAR and Beclin1 levels might be helpful to predict the prognosis of patients with HBV-ACLF.

关 键 词：慢加急性肝衰竭 可溶性生长刺激表达基因2 Toll样受体4 可溶性人尿激酶型纤溶酶原激活物受体 自噬相关蛋白 预后 

分 类 号：R54[医药卫生—心血管疾病]