血清wnt5a和LC3-Ⅱ联合MELD评分预测慢加急性乙型肝炎肝衰竭患者短期预后价值探讨OACSTPCD
Predictive efficacy of serum wnt5a and LC3-Ⅱ levels and MELD score for short-term prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure
目的 探讨血清无翅型MMTV整合位点5a(wnt5a)和微血管相关蛋白1 轻链3-Ⅱ(LC3-Ⅱ)水平联合终末期肝病模型(MELD)评分预测慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者短期预后的价值.方法 2018 年 1 月～2022 年12 月我院诊治的 152 例HBV-ACLF患者,常规内科和人工肝治疗,计算MELD评分,采用ELISA法检测血清wnt5a和LC3-Ⅱ水平,应用Logistic回归分析影响HBV-ACLF患者短期预后的因素,应用受试者工作特征(ROC)曲线评估血清wnt5a和LC3-Ⅱ联合MELD评分预测HBV-ACLF患者短期预后的效能.结果 在治疗 3 个月内,本组HBV-ACLF患者死亡40 例(26.3%);死亡组年龄、肝性脑病发生率、INR、血清总胆红素水平、MELD评分和wnt5a水平分别为(51.3±5.1)岁、70.0%、(3.2±0.9)、(441.5±89.7)μmol/L、(28.2±4.3)分和(2.8±1.5)ng/mL,均显著大于生存组[分别为(45.4±4.6)岁、20.0%、(1.7±0.3)、(280.6±73.1)μmol/L、(19.7±2.8)分和(1.3±0.2)ng/mL,P<0.05],而外周血血小板计数和血清LC3-Ⅱ水平分别为(77.8±10.3)×109/L和(20.6±2.1)μg/mL,显著低于生存组[分别为(116.4±11.7)×109/L和(32.5±3.9)μg/mL,P<0.05];多因素Logistic回归分析显示,年龄大、并发肝性脑病和血清wnt5a升高或血清LC3-Ⅱ水平降低为影响HBV-ACLF患者短期预后的独立影响因素(P<0.05);以MELD评分大于 26.9 分为截断点,其预测ACLF患者短期死亡的灵敏度和特异度分别为80.0%和92.9%,而检测血清wnt5a和LC3-Ⅱ水平也可以协助判断.结论 血清wnt5a和LC3-Ⅱ联合MELD评分对HBV-ACLF患者短期预后具有较好的预测价值.
Objective The aim of this study was to explore the predictive efficacy of serum wingless-type MMTV integration site family member 5a(wnt5a)and microtubule-associated protein 1 light chain 3 Ⅱ(LC3-Ⅱ)levels and the model of end-stage liver disease(MELD)score for short-term prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods A total of 152 patients with HBV-ACLF were encountered in our hospital between January 2018 and December 2022,and all patients were routinely carefully managed for supporting and anti-viral treatment.The MELD scores were calculated,and serum serum wnt5a and LC3-Ⅱ levels were detected by ELISA.The influencing factors of short-term prognosis in patients with HBV-ACLF were analyzed by the Logistic regression analysis,and the predictive performance was evaluated by the receiver operating characteristic(ROC)curves.Results At the end of three month treatment,112 patients survived of liver failure and 40(26.3％)patients died;the age,incidence of hepatic encephalopathy(HE),INR,total serum bilirubin level,MELD score and serum wnt5a level in dead patients were(51.3±5.1)yr,70.0％,(3.2±0.9),(441.5±89.7)μmol/L,(28.2±4.3)and(2.8±1.5)ng/mL,all significantly higher or greater than[(45.4±4.6)yr,20.0％,(1.7±0.3),(280.6±73.1)μmol/L,(19.7±2.8)and(1.3±0.2)ng/mL,respectively,P<0.05],while blood platelet count and serum LC3-Ⅱlevel were(77.8±10.3)×109/L and(20.6±2.1)μg/mL,both significantly lower than[(116.4±11.7)×109/L and(32.5±3.9)μg/mL,respectively,P<0.05]in the survivals;the multivariate Logistic regression analysis showed that the age,HE,elevated serum wnt5a level or reduced serum LC3-Ⅱ level were all the factors impacting the short-term prognosis(P<0.05);the sensitivity and the specificity were 80.0％and 92.9％,respectively when the MELD score greater than 26.9 was set as the cut-off-value in predicting the short-term prognosis in patients with HBV-ACLF,and the detection of serum wnt5a and LC3-Ⅱ levels could improve the prediction.Conclusion The combination of serum wnt5a and LC3-Ⅱ levels and MELD score is efficacious in predicting the short-term prognosis of patients with HBV-ACLF.
黄静;王菁;方亮;周娟;商惠民
438000 湖北省黄冈市中心医院消化内科武汉大学附属中南医院消化内科黄冈市中医医院超声科
慢加急性肝衰竭无翅型MMTV整合位点5a微血管相关蛋白1轻链3-Ⅱ终末期肝病模型评分预后预测
Acute-on-chronic liver failureWingless-type MMTV integration site family member 5aMicrotubule-associated protein 1 light chain 3 ⅡModel of end-stage liver diseasePrognosisPrediction
《实用肝脏病杂志》 2024 (004)
551-554 / 4
湖北省科技厅科研基金面上项目(编号:2021HG02410)
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