关键词: 肝功能衰竭, 乙型肝炎, 脂联素, 预后

Abstract: Objective To investigate the changes and clinical significance of plasma adiponectin（ADPN） in patients with hepatitis B virus-related acute-on chronic liver failure（HBV-ACLF）. Methods Eighty-two patients with HBV-ACLF admitted to our department from Jan，2009 to Dec，2012 were included in this study. Clinical data were collected，and plasma ADPN was determined with ELISA. Patients were further divided into survival and dead group according to the clinical outcome at the end of 30 day hospitalization. The differences in plasma ADPN and model for end-stage liver disease （MELD） score between these two group were determined，and multivariate logistic regression analysis was used to evaluate the significance of ADPN and MELD score in prognosis of short-term survival. Results The plasma levels of ADPN at early-stage （n=24），middle-stage（n=30） and end-stage （n=28） of patients with HBV-ACLF were （0.68±0.15）ng/ml，（0.76±0.17） ng/ml and （0.89±0.18） ng/ml，respectively，which significantly increased with the progress of liver failure（F=12.30，P<0.01）；No significant differences as respect to gender，age，AST，ALT，white blood cells and HBV DNA load were observed between 30 survival and 52 dead patients，however，the plasma ADPN and MELD scores in survival patients were （0.7±0.2）ng/ml and （26.3±6.4），respectively，both significantly lower than those in dead patients[（0.82±0.18）ng/ml and（37.9±8.1），respectively，P<0.01]；Multivariate logistic regression analysis showed that MELD score（OR=1.43，95%CI:1.22-1.65，P<0.01），plasma level of ADPN （OR=1.23，95%CI:1.12-1.34，P<0.01），serum albumin （OR=1.18，95%CI:1.11-1.26，P<0.01） and AST/ALT ratio（OR=1.06，95%CI:1.01-1.11，P<0.01） were independent risk factors for short-term prognosis in patients with HBV-ACLF. Conclusions Plasma level of ADPN is associated with the progress of liver dysfunction，and an increase in plasma level of ADPN indicates a poor short-term prognosis in patients with HBV-ACLF.

Key words: Liver failure, Hepatitis B, Adiponectin, Prognosis