可溶性甘露糖受体作为乙型肝炎病毒相关慢加急性肝衰竭预后的预测因子。
Soluble mannose receptor as a predictor of prognosis of hepatitis B virus-related acute-on-chronic liver failure.
机构信息
Department of Clinical Laboratory, The Second Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China.
出版信息
World J Gastroenterol. 2019 Oct 7;25(37):5667-5675. doi: 10.3748/wjg.v25.i37.5667.
BACKGROUND
Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a syndrome with a high short-term mortality rate, and it is crucial to identify those patients at a high mortality risk clinically.
AIM
To investigate the clinical value of soluble mannose receptor (sMR) in predicting the 90-day mortality of HBV-ACLF patients.
METHODS
A total of 43 patients were diagnosed with HBV-ACLF between October 2017 and October 2018 at the Second Hospital of Anhui Medical University, and all of them were enrolled in this retrospective study. Their serum sMR levels were determined using an enzyme-linked immunosorbent assay. Demographic and clinical data, including gender, age, albumin level, total bilirubin (TBIL) level, international normalized ratio, HBV-DNA level, HBV serological markers, procalcitonin level, interleukin-6 level, and model for end-stage liver disease (MELD) score were accessed at the time of diagnosis of HBV-ACLF. A multivariate logistic regression analysis was used to analyze the independent risk factors for mortality.
RESULTS
Serum sMR level was significantly increased in HBV-ACLF patients compared with chronic hepatitis B patients and healthy controls ( < 0.01). When compared with surviving patients, it was higher in those patients who succumbed to HBV-ACLF ( < 0.05). Serum sMR level was positively correlated with MELD score ( = 0.533, = 0.001), HBV-DNA level ( = 0.497, = 0.022), and TBIL level ( = 0.894, < 0.001). Serum sMR level (odds ratio = 1.007, 95% confidence interval: 1.004-1.012, = 0.001) was an independent risk factor for the 90-day mortality in the HBV-ACLF cases. The patients with HBV-ACLF were stratified into two groups in accordance with their serum sMR levels at the baseline (low risk: < 99.84 pg/mL and high risk: ≥ 99.84 pg/mL). The 90-day mortality rates were 27.3% in the low-risk group and 87.5% in the high-risk group. Furthermore, sMR level apparently improved the performance of MELD score for predicting the prognosis of patients with HBV-ACLF.
CONCLUSION
Serum sMR level may be a predictor of the prognosis of HBV-ACLF patients.
背景
乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）是一种短期死亡率较高的综合征，临床上识别那些高死亡风险的患者至关重要。
目的
探讨可溶性甘露糖受体（sMR）在预测 HBV-ACLF 患者 90 天死亡率中的临床价值。
方法
2017 年 10 月至 2018 年 10 月，安徽医科大学第二附属医院诊断为 HBV-ACLF 的 43 例患者被纳入本回顾性研究。采用酶联免疫吸附试验测定其血清 sMR 水平。在诊断 HBV-ACLF 时，获取患者的人口统计学和临床数据，包括性别、年龄、白蛋白水平、总胆红素（TBIL）水平、国际标准化比值、HBV-DNA 水平、HBV 血清标志物、降钙素原水平、白细胞介素-6 水平和终末期肝病模型（MELD）评分。采用多变量 logistic 回归分析死亡的独立危险因素。
结果
与慢性乙型肝炎患者和健康对照组相比，HBV-ACLF 患者的血清 sMR 水平显著升高（<0.01）。与存活患者相比，死于 HBV-ACLF 的患者 sMR 水平更高（<0.05）。血清 sMR 水平与 MELD 评分呈正相关（r=0.533，P=0.001）、HBV-DNA 水平（r=0.497，P=0.022）和 TBIL 水平（r=0.894，P<0.001）。血清 sMR 水平（比值比=1.007，95%置信区间：1.004-1.012，P=0.001）是 HBV-ACLF 患者 90 天死亡率的独立危险因素。根据基线时血清 sMR 水平（低风险：<99.84pg/mL 和高风险：≥99.84pg/mL）将 HBV-ACLF 患者分为两组。低风险组 90 天死亡率为 27.3%，高风险组为 87.5%。此外，sMR 水平明显提高了 MELD 评分预测 HBV-ACLF 患者预后的性能。
结论
血清 sMR 水平可能是 HBV-ACLF 患者预后的预测指标。
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