Qin S, Tang S H, Wang X H, Wang X P, Sun M Y, Wu X L, Zeng W Z
Department of Medicine, Southwest Jiaotong University, Chengdu 610003, China.
Department of Medicine, Southwest Jiaotong University, Chengdu 610003, China; Department of Gastroenterology, General Hospital of Western Theater, Chengdu 610083, China.
Zhonghua Gan Zang Bing Za Zhi. 2020 Jan 20;28(1):69-72. doi: 10.3760/cma.j.issn.1007-3418.2020.01.016.
To investigate the value of alpha-fetoprotein (AFP) level on survived hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) patients treated with artificial liver. Clinical indicators of HBV-ACLF patients who were previously treated with plasma exchange-based artificial liver at our department were retrospectively collected. The difference of serum AFP level between the survival and the death group was compared at 30, 90 and 180 days after artificial liver treatment. The ROC curves of the subjects were plotted, and the sensitivity and specificity of AFP for the survival prediction of the patients at 30, 90 and 180 days after artificial liver surgery were calculated. AFP was divided into a high AFP group and a low AFP group using median value. AFP and postoperative survival predictive value at 30, 90, and 180 days were analyzed. A total of 93 cases were included in this study. The AFP of the survival group at 30, 90, and 180 days was (231.0 ± 286.2) ng / ml, (237.69 ± 297) ng / ml, (229.44 ± 286.46) ng/ml, and the death group was (76.4 ± 104.7) ng/ml, (103.13 ± 116.99) ng / ml, (136.34 ± 2.9.29) ng/ml, respectively. AFP of the death group was significantly lower than the corresponding survival group ( < 0.05). Receiver operating characteristic (ROC) curve analyses indicated that the area under the curve (AUC) and its 95% confidence interval at 30, 90, and 180 days after artificial liver surgery were 0.739 (0.611 ~ 0.867), 0.675 (0.550 ~ 0.80), 0.653 (0.524 ~ 0.781), respectively. The median serum AFP value was 110 ng/ml, and the survival analysis showed that the survival time of the high AFP group was significantly higher than the low AFP group at 30 d ( = 0.01), 90 d ( = 0.04) and 180 d ( = 0.03) after artificial liver surgery. Serum AFP can be used as a predictor of survival for HBV-ACLF patients after artificial liver therapy and its clinical value needs to be further verified by the larger sample size.
探讨甲胎蛋白（AFP）水平对接受人工肝治疗的存活乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者的价值。回顾性收集我科既往接受基于血浆置换的人工肝治疗的HBV-ACLF患者的临床指标。比较人工肝治疗后30天、90天和180天存活组与死亡组血清AFP水平的差异。绘制受试者的ROC曲线，并计算人工肝治疗后30天、90天和180天AFP对患者存活预测的敏感性和特异性。以中位数将AFP分为高AFP组和低AFP组。分析人工肝治疗后30天、90天和180天AFP与术后存活预测价值。本研究共纳入93例患者。存活组人工肝治疗后30天、90天和180天的AFP分别为（231.0±286.2）ng/ml、（237.69±297）ng/ml、（229.44±286.46）ng/ml，死亡组分别为（76.4±104.7）ng/ml、（103.13±116.99）ng/ml、（136.34±2.9.29）ng/ml。死亡组AFP显著低于相应存活组（<0.05）。受试者工作特征（ROC）曲线分析表明，人工肝治疗后30天、90天和180天曲线下面积（AUC）及其95%置信区间分别为0.739（0.6110.867）、0.675（0.5500.80）、0.653（0.524~0.781）。血清AFP中位数为110 ng/ml，生存分析表明，人工肝治疗后30天（=0.01）、90天（=0.04）和180天（=0.03）高AFP组的生存时间显著高于低AFP组。血清AFP可作为人工肝治疗后HBV-ACLF患者存活的预测指标，其临床价值有待更大样本量进一步验证。
