Yang Kai, Pan Ying, Jin Lei, Yu Furong, Zhang Fasu
Department of Medical Technology, Anhui Medical College, Hefei, 230601, Anhui, China.
Department of Infectious Disease, the Second Hospital of Anhui Medical University, Hefei, 230601, Anhui, China.
Biol Trace Elem Res. 2023 Jun;201(6):2757-2764. doi: 10.1007/s12011-022-03385-2. Epub 2022 Aug 15.
Iron metabolism disorder is closely related to acute-on-chronic liver failure (ACLF). This study was conducted to analyze the serum levels of soluble transferrin receptor (sTfR) in hepatitis B virus (HBV)-related ACLF and to evaluate the predictive value of sTfR for the short-term prognosis of HBV-ACLF. A total of 359 patients, including 139 with HBV-ACLF, 103 with chronic hepatitis B (CHB), and 117 healthy controls (HCs), participated in this study. We measured serum levels of ferritin, transferrin, and sTfR using nephelometry and performed data analysis using SPSS software. Ferritin levels were significantly higher in HBV-ACLF patients (both P < 0.001), while transferrin and sTfR were significantly lower (all P < 0.001) than in patients with CHB and HCs. Spearman correlation analysis demonstrated that serum sTfR significantly correlated with the alanine aminotransferase (ALT) (r = -0.366, P < 0.001), aspartate aminotransferase (AST) (r = -0.322, P < 0.001), total bilirubin (TBIL) (r = -0.222, P = 0.009), alpha fetoprotein (AFP) (r = 0.329, P < 0.001), prothrombin time-international normalization ratio (PT-INR) (r = -0.428, P < 0.001), and model for end-stage liver disease (MELD) (r = -0.459, P < 0.001). Nonsurviving HBV-ACLF patients who died within 30 days had much lower serum sTfR levels than surviving patients (P < 0.001). Logistic regression analysis showed that decreased serum sTfR levels were independently associated with 30-day mortality in patients with HBV-ACLF (P = 0.003). Receiver operating characteristic (ROC) curve analysis for predicting 30-day mortality showed that the area under the curve (AUC) for serum sTfR was 0.813 (95% CI: 0.738-0.874, P < 0.001). This was similar to that of the MELD score (AUC = 0.812, 95% CI: 0.737-0.873, P < 0.001). Serum sTfR combined with MELD score significantly improved the predictive capacity for 30-day mortality in patients with HBV-ACLF (AUC = 0.871, 95% CI: 0.803-0.922, P < 0.001). Kaplan-Meier analysis revealed that the overall cumulative 30-day mortality rate was significantly higher in patients with serum sTfR levels ≤ 0.55 mg/L compared to those with serum sTfR levels > 0.55 mg/L (P < 0.001).
铁代谢紊乱与慢加急性肝衰竭（ACLF）密切相关。本研究旨在分析乙型肝炎病毒（HBV）相关ACLF患者血清可溶性转铁蛋白受体（sTfR）水平，并评估sTfR对HBV-ACLF短期预后的预测价值。共有359例患者参与本研究，其中139例为HBV-ACLF患者，103例为慢性乙型肝炎（CHB）患者，117例为健康对照（HC）。我们采用散射比浊法检测血清铁蛋白、转铁蛋白和sTfR水平，并使用SPSS软件进行数据分析。HBV-ACLF患者的铁蛋白水平显著更高（均P<0.001），而转铁蛋白和sTfR水平显著低于CHB患者和HC（均P<0.001）。Spearman相关性分析表明，血清sTfR与丙氨酸氨基转移酶（ALT）（r=-0.366，P<0.001）、天冬氨酸氨基转移酶（AST）（r=-0.322，P<0.001）、总胆红素（TBIL）（r=-0.222，P=0.009）、甲胎蛋白（AFP）（r=0.329，P<0.001）、凝血酶原时间-国际标准化比值（PT-INR）（r=-0.428，P<0.001）及终末期肝病模型（MELD）（r=-0.459，P<0.001）显著相关。30天内死亡的未存活HBV-ACLF患者血清sTfR水平远低于存活患者（P<0.001）。Logistic回归分析显示，血清sTfR水平降低与HBV-ACLF患者30天死亡率独立相关（P=0.003）。预测30天死亡率的受试者工作特征（ROC）曲线分析显示，血清sTfR的曲线下面积（AUC）为0.813（95%CI：0.738-至0.874，P<0.001）。这与MELD评分相似（AUC=0.812，95%CI：0.737-0.873，P<0.001）。血清sTfR与MELD评分联合显著提高了HBV-ACLF患者30天死亡率的预测能力（AUC=0.871，95%CI：0.803-0.922，P<0.001）。Kaplan-Meier分析显示，血清sTfR水平≤0.55mg/L的患者30天总体累积死亡率显著高于血清sTfR水平>0.55mg/L的患者（P<0.001）。
