低淋巴细胞与单核细胞比值、骨化三醇水平和CD206水平可预测急性失代偿期肝硬化患者发生慢加急性肝衰竭的风险。
Low lymphocyte-to-monocyte ratio, calcitriol level, and CD206 level predict the development of acute-on-chronic liver failure in patients cirrhosis with acute decompensation.
作者信息
Kuo Nai-Rong, Hou Ming-Chih, Chu Wei-Chi, Yang Ying-Ying, Huang Chia-Chang, Li Tzu-Hao, Lee Tzung-Yan, Liu Chih-Wei, Liao Tsai-Ling, Hsieh Shie-Liang, Lin Han-Chieh
机构信息
Department of Medical Education, Medical Innovation and Research Office, Clinical Innovation Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
出版信息
J Chin Med Assoc. 2023 Mar 1;86(3):265-273. doi: 10.1097/JCMA.0000000000000867. Epub 2023 Jan 23.
BACKGROUND
Cirrhosis-related acute-on-chronic liver failure (ACLF) is associated with high morbidity and mortality rates. Prognostic models of ACLF have been developed; however, few studies have focused on the occurrence of ACLF. This study aimed to identify the factors that predict the development of ACLF, hepatic encephalopathy (HE), and infection in patients with cirrhosis.
METHODS
Patients with cirrhosis were enrolled, and the serum levels of calcitriol, Cluster of Differentiation 26 (CD206), and macrophage-inducible lectin receptor (Mincle) were measured, and lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio were calculated; all the patients were tracked for 6 months. A generalized estimating equation (GEE) was used to assess the factors associated with ACLF development, HE, and infection. The aforementioned model was derived based on immunological markers, and receiver operating characteristic analysis with area under the curve (AUC) was adopted to evaluate accuracy.
RESULTS
After screening 325 patients with cirrhosis, 65 patients were eligible. In the GEE model, low levels of calcitriol (odds ratio [OR] = 3.259; 95% confidence interval [CI] = 1.118-8.929) and CD206 (OR = 2.666; 95% CI = 1.082-6.567) were associated with the development of ACLF, and the LMR was a protective factor (OR = 0.356; 95% CI = 0.147-0.861). Low calcitriol levels were a risk factor for HE (OR = 3.827) and infection (OR = 2.489). LMR was found to be a protective factor against HE (OR = 0.388). An immunological model for the discrimination of ACLF development within 6 months was proposed, with an AUC of 0.734 (95% CI = 0.598-0.869).
CONCLUSION
Single and combined immunological markers, including low LMR and low levels of calcitriol and CD206, were promising for early prediction of the development of ACLF, HE, and infection in patients with cirrhosis.
背景
肝硬化相关的慢加急性肝衰竭（ACLF）与高发病率和死亡率相关。已经开发了ACLF的预后模型；然而，很少有研究关注ACLF的发生情况。本研究旨在确定预测肝硬化患者发生ACLF、肝性脑病（HE）和感染的因素。
方法
纳入肝硬化患者，检测血清骨化三醇、分化簇26（CD206）和巨噬细胞诱导性凝集素受体（Mincle）水平，并计算淋巴细胞与单核细胞比值（LMR）和中性粒细胞与淋巴细胞比值；对所有患者进行6个月的跟踪。采用广义估计方程（GEE）评估与ACLF发生、HE和感染相关的因素。上述模型基于免疫标志物推导得出，并采用曲线下面积（AUC）的受试者工作特征分析来评估准确性。
结果
在筛选的325例肝硬化患者中，65例符合条件。在GEE模型中，骨化三醇水平低（比值比[OR]=3.259；95%置信区间[CI]=1.118-8.929）和CD206水平低（OR=2.666；95%CI=1.082-6.567）与ACLF的发生相关，而LMR是一个保护因素（OR=0.356；95%CI=0.147-0.861）。骨化三醇水平低是HE（OR=3.827）和感染（OR=2.489）的危险因素。发现LMR是预防HE的保护因素（OR=0.388）。提出了一种用于判别6个月内ACLF发生情况的免疫模型，AUC为0.734（95%CI=0.598-0.869）。
结论
单一和联合免疫标志物，包括低LMR以及低骨化三醇和CD206水平，有望用于早期预测肝硬化患者发生ACLF、HE和感染的情况。
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