Liver Failure and Artificial Liver Treatment Research, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
Crit Rev Eukaryot Gene Expr. 2022;32(6):47-56. doi: 10.1615/CritRevEukaryotGeneExpr.2022041680.
We aimed to explore the relationship between free triiodothyronine (FT3) level and severity of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). A total of 122 patients with HBV-ACLF who were hospitalized in Beijing You'an Hospital Affiliated to Capital Medical University from September 2018 to February 2020 were included in this study. The FT3 level and the number of organs involved in patients with different stages of liver failure were analyzed. The patients were divided into four groups, Q1, Q2, Q3, and Q4, according to FT3 level. Correlation analysis was used to compare the correlation between FT3 level and Model for End-Stage Liver Disease (MELD) score, chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score, CLIF-consortium organ failure (CLIF-COF) score, and Asian Pacific Association for the Study of the Liver (APASL) acute-on-chronic liver failure (ACLF) Research Consortium (AARC) score. Multiple linear regression, logistic regression and receiver operating characteristic (ROC) curve were used to analyze the effect of FT3 on MELD score. The FT3 level was the lowest in patients with advanced HBV-ACLF, but the highest in patients with early-stage HBV-ACLF (P < 0.01). The more organs involved, the lower the level of FT3 (P < 0.01). The MELD score of Q4 group was the lowest, whereas that of Q1 group was the highest (P < 0.01). Pearson correlation coefficients of FT3 with MELD score, CLIF-SOFA score, CLIF-COF score and AARC score were -0.477, -0.359, -0.347, and -0.391, respectively (P < 0.001). Multiple linear regression analysis showed that the partial regression coefficients of FT3, natural log total bilirubin in milligrams per decaliter {ln[TBIL (mg/dL)]}, natural log creatinine in milligrams per decaliter {ln[CR (mg/dL)]}, and natural log international normalized ratio {ln[INR]} were -0.215, 0.346, 0.231, and 0.667, respectively (P < 0.001). The odds ratio (OR) values of FT3, ln[TBIL (mg/dL)], ln[CR (mg/dL)], and ln[INR] were 0.141 (0.082-0.244), 5.426 (2.697-9.059), 4.535 (2.432-8.455), and 8.642 (6.679-10.267) in the MELD ≥ 30 group compared with MELD < 30 group (P < 0.001). Furthermore, their area under the ROC curve (AUROC) values were 0.739 (0.686-0.792), 0.748 (0.696-0.800), 0.632 (0.562-0.702), and 0.933 (0.903-0.963), respectively (P < 0.001). FT3 level is correlated with the severity of HBV-ACLF, which may be one of the factors to judge the severity of this disease.
本研究旨在探讨游离三碘甲状腺原氨酸（FT3）水平与乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）严重程度的关系。选取 2018 年 9 月至 2020 年 2 月首都医科大学附属北京佑安医院收治的 122 例 HBV-ACLF 患者，分析不同肝功能衰竭分期患者 FT3 水平及受累器官数目，根据 FT3 水平将患者分为 Q1、Q2、Q3、Q4 四组，采用相关性分析比较 FT3 水平与终末期肝病模型（MELD）评分、慢性肝脏衰竭-序贯器官衰竭评估（CLIF-SOFA）评分、CLIF 联盟器官衰竭（CLIF-COF）评分、亚太肝病学会（APASL）慢加急性肝衰竭（ACLF）研究联盟（AARC）评分的相关性。采用多元线性回归、Logistic 回归及受试者工作特征（ROC）曲线分析 FT3 对 MELD 评分的影响。结果显示，随着 HBV-ACLF 病情加重，FT3 水平逐渐降低，早期 HBV-ACLF 患者 FT3 水平最高，晚期 HBV-ACLF 患者 FT3 水平最低（P<0.01）；受累器官数目越多，FT3 水平越低（P<0.01）。Q4 组 MELD 评分最低，Q1 组 MELD 评分最高（P<0.01）。FT3 与 MELD 评分、CLIF-SOFA 评分、CLIF-COF 评分、AARC 评分的 Pearson 相关系数分别为-0.477、-0.359、-0.347、-0.391（P<0.001）。多元线性回归分析结果显示，FT3、血清总胆红素的自然对数[ln（TBIL，mg/dL）]、血清肌酐的自然对数[ln（CR，mg/dL）]、国际标准化比值的自然对数[ln（INR）]的偏回归系数分别为-0.215、0.346、0.231、0.667（P<0.001）。FT3、ln（TBIL，mg/dL）、ln（CR，mg/dL）、ln（INR）的比值比（OR）值分别为 0.141（0.0820.244）、5.426（2.6979.059）、4.535（2.4328.455）、8.642（6.67910.267），MELD≥30 组高于 MELD<30 组（P<0.001）。FT3、ln（TBIL，mg/dL）、ln（CR，mg/dL）、ln（INR）的 ROC 曲线下面积（AUROC）值分别为 0.739（0.6860.792）、0.748（0.6960.800）、0.632（0.5620.702）、0.933（0.9030.963），MELD≥30 组高于 MELD<30 组（P<0.001）。FT3 水平与 HBV-ACLF 的严重程度相关，可能是判断该病严重程度的因素之一。
