尿肝型脂肪酸结合蛋白(L-FABP)对慢加急性肝衰竭短期预后的预测价值
Value of urinary liver fatty acid-binding protein in predicting the short-term prognosis of patients with acute-on-chronic liver failure
摘要
Abstract
Objective To investigate the value of liver fatty acid-binding protein(L-FABP)in predicting the severity and short-term prognosis of patients with acute-on-chronic liver failure(ACLF).Methods A total of 149 patients with ACLF were selected from a prospective multicenter cohort assessing the platelet function of ACLF patients,and according to the 28-day prognosis after admission,they were divided into survival group with 97 patients and death group with 52 patients.The patients were analyzed in terms of sex,age,etiology,and blood routine,biochemical parameters,and organ failure status within 24 hours after admission,and the level of L-FABP in urine and blood was measured.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.The Spearman test was used to evaluate the correlation between urinary L-FABP and indicators for liver failure.The receiver operating characteristic(ROC)curve was plotted to assess the value of CLIF-OFs,MELD score,and urinary L-FABP in predicting the short-term prognosis of ACLF patients;the Kaplan-Meier analysis was used to evaluate short-term mortality in the high urinary L-FABP group and the low urinary L-FABP group;the Cox proportional hazards model was used to investigate the association of each factor with the short-term prognosis of ACLF.Results There were significant differences between the two groups in white blood cell count,serum total bilirubin(TBil),international normalized ratio,CLIF-OFs,MELD score,urinary L-FABP level,and the proportion of patients with cerebral failure,liver failure,coagulation failure,renal failure,or respiratory failure(all P<0.05).The Spearman correlation analysis showed that urinary L-FABP was significantly positively correlated with serum TBil(r=0.225,P=0.006).Urinary L-FABP level had an area under the ROC curve of 0.804(95%confidence interval[CI]:0.729-0.865,P<0.001)and a cut-off value of 4.779 μg/dL,with a sensitivity of 73.08%,a specificity of 73.91%,and a Youden index of 0.469 9.The Kaplan-Meier survival analysis showed that compared with the low urinary L-FABP group(urinary L-FABP≤4.779 μg/dL),the high urinary L-FABP group(urinary L-FABP>4.779 μg/dL)had a significantly lower 28-day survival rate(P<0.001).The Cox proportional hazards model analysis showed that serum TBil(hazard ratio[HR]=1.003,95%CI:1.001-1.004,P<0.05),CLIF-OFs(HR=2.283,95%CI:1.814-2.873,P<0.05),and high urinary L-FABP level(HR=4.568,95%CI:2.424-8.608,P<0.05)were independent risk factors for the short-term prognosis of ACLF.Conclusion High urinary L-FABP level can be used as a clinical indicator for predicting the short-term prognosis of ACLF,and further studies with larger sample sizes are needed to evaluate its predictive value.关键词
慢加急性肝功能衰竭/肝硬化/脂肪酸结合蛋白质类/预后Key words
Acute-On-Chronic Liver Failure/Liver Cirrhosis/Fatty Acid-Binding Proteins/Prognosis引用本文复制引用
吴华兰,洪畅泽,蒋秀华,陈金军..尿肝型脂肪酸结合蛋白(L-FABP)对慢加急性肝衰竭短期预后的预测价值[J].临床肝胆病杂志,2024,40(8):1639-1645,7.基金项目
国家重点研发专项(2022YFC2304800) （2022YFC2304800）
国家自然科学基金(82370614,82070650) （82370614,82070650）
国家科技部重大专项(2018ZX10723203) （2018ZX10723203）
广东省珠江人才计划(2017BT01S131) （2017BT01S131）
南方医院"临床研究专项"(2018CR037,2020CR026) （2018CR037,2020CR026）
南方医科大学临床启动计划(LC2019ZD006) （LC2019ZD006）
南方医院院长基金(2019Z003) （2019Z003）
广东省重点领域研发计划(2019B020227004) National Key Research and Development Program of China(2022YFC2304800) （2019B020227004）
National Natural Science Foundation of China(82370614,82070650) （82370614,82070650）
National Science and Technology Major Project(2018ZX10723203) （2018ZX10723203）
Local Innovative and Research Teams Project of Guangdong Pearl River Talents Program(2017BT01S131) （2017BT01S131）
Clinical Research Program of Nanfang Hospital,Southern Medical University(2018CR037,2020CR026) （2018CR037,2020CR026）
Clinical Research Startup Program of Southern Medical University by High-level University Construction Funding of Guangdong Provincial Department of Education(LC2019ZD006) （LC2019ZD006）
President Foundation of Nanfang Hospital,Southern Medical University(2019Z003) （2019Z003）
Key-Area Research and Development Program of Guangdong Province(2019B020227004) （2019B020227004）
