血清外泌体来源的醛脱氢酶1A1可极大地预测戊型肝炎病毒相关急性肝衰竭患者的预后。

Serum exosome-derived ALDH1A1 can greatly predict the prognosis of patients with hepatitis E virus-related acute liver failure.

作者信息

Shang An-Quan, Yan Hong, Xiang Ze, Chen Jia-Qi, Jiang Bin, Jiang Chun, Ling Bai, Wu Jian

机构信息

Department of Laboratory Medicine, The Second People's Hospital of Lianyungang & The Oncology Hospital of Lianyungang, Lianyungang 222006, China.

Laboratory Medicine Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China.

出版信息

Hepatobiliary Pancreat Dis Int. 2025 Apr;24(2):170-176. doi: 10.1016/j.hbpd.2024.12.007. Epub 2024 Dec 25.

DOI:10.1016/j.hbpd.2024.12.007

PMID:39753426

Abstract

BACKGROUND

Despite the insights into the role of aldehyde dehydrogenase 1 family member A1 (ALDH1A1) in various liver diseases, the expression and its prognostic significance in patients with hepatitis E virus-related acute liver failure (HEV-ALF) remain unclear. This study delved into the assessment of serum exosome-derived ALDH1A1 expression and its prognostic implications for HEV-ALF patients.

METHODS

Between January 2018 and December 2023, a total of 226 individuals with acute hepatitis E (AHE) and 210 patients with HEV-ALF were recruited from member units of Chinese Consortium for the Study of Hepatitis E. According to the number of organ failure, we categorized 210 HEV-ALF patients into three groups: two organs failure (n = 131), three organs failure (n = 46), and more than three organs failure (n = 33). In addition, 200 health controls from Suzhou Municipal Hospital were included.

RESULTS

The levels of serum exosome-derived ALDH1A1 in HEV-ALF patients were significantly higher than those in AHE patients and health controls (both P < 0.05). Furthermore, the levels of serum exosome-derived ALDH1A1 were the highest in more than three organs failure group, followed by three organs failure group and two organs failure group (all P < 0.001). Moreover, serum exosome-derived ALDH1A1 was positively correlated with total bilirubin in HEV-ALF patients (r = 0.315, P < 0.001). The comparisons of serum exosome-derived ALDH1A1 levels in treatment response showed that serum exosome-derived ALDH1A1 levels were decreased in the improvement group, while increased in the fluctuation and deterioration groups (all P < 0.001). Moreover, serum exosome-derived ALDH1A1 was an independent risk factor for predicting the 30-day mortality (P < 0.001). Furthermore, the area under the receiver operating characteristic curve was 0.943, with the sensitivity of 94.87% and specificity of 87.72%, indicating the robust decision-making ability. However, no significant differences were found in serum exosome-derived ALDH1A1 levels between patients aged < 60 and ≥ 60 years old (P = 0.131).

CONCLUSIONS

Serum exosome-derived ALDH1A1 can greatly predict the prognosis of HEV-ALF patients.

摘要

背景

尽管对醛脱氢酶1家族成员A1（ALDH1A1）在各种肝脏疾病中的作用已有深入了解，但其在戊型肝炎病毒相关急性肝衰竭（HEV-ALF）患者中的表达及其预后意义仍不清楚。本研究深入评估了血清外泌体来源的ALDH1A1表达及其对HEV-ALF患者的预后影响。

方法

2018年1月至2023年12月，从中国戊型肝炎研究联盟成员单位招募了226例急性戊型肝炎（AHE）患者和210例HEV-ALF患者。根据器官衰竭数量，将210例HEV-ALF患者分为三组：两个器官衰竭（n = 131）、三个器官衰竭（n = 46）和三个以上器官衰竭（n = 33）。此外，纳入了苏州市立医院的200名健康对照者。

结果

HEV-ALF患者血清外泌体来源的ALDH1A1水平显著高于AHE患者和健康对照者（均P < 0.05）。此外，血清外泌体来源的ALDH1A1水平在三个以上器官衰竭组中最高，其次是三个器官衰竭组和两个器官衰竭组（均P < 0.001）。此外，HEV-ALF患者血清外泌体来源的ALDH1A1与总胆红素呈正相关（r = 0.315，P < 0.001）。治疗反应中血清外泌体来源的ALDH1A1水平比较显示，改善组血清外泌体来源的ALDH1A1水平降低，而波动组和恶化组升高（均P < 0.001）。此外，血清外泌体来源的ALDH1A1是预测30天死亡率的独立危险因素（P < 0.001）。此外，受试者工作特征曲线下面积为0.943，敏感性为94.87%，特异性为87.72%，表明其决策能力较强。然而，年龄<60岁和≥60岁的患者血清外泌体来源的ALDH1A1水平无显著差异（P = 0.131）。