实用肝脏病杂志 ›› 2016, Vol. 19 ›› Issue (3): 301-304.doi: 10.3969/j.issn.1672-5069.2016.03.012

• 肝衰竭 • 上一篇    下一篇

慢加急性肝衰竭前期患者血清M30和M65水平预测预后价值探讨*

黄小平,吴云辉,王艳,甘建和   

  1. 215006 江苏省苏州市 苏州大学附属第一医院感染病科(黄小平,王艳,甘建和);浙江省嘉兴县人民医院感染病科(吴云辉)
  • 收稿日期:2015-08-31 出版日期:2016-05-10 发布日期:2016-05-20
  • 通讯作者: 甘建和 ,E-mail:jianhegan@yahoo.com
  • 作者简介:黄小平,男,36岁, 主治医师。主要从事肝衰竭的基础和临床研究。E-mail:grehxp@163.com
  • 基金资助:
    “十二五”国家传染病科技重大专项 (2012ZX10002-004)

Serum M30 and M65 levels in patients with acute-on-chronic pre-liver failure

Huang Xiaoping,Wu Yunhui,Wang Yan,et al.   

  1. Department of Infectious Disease,First Affiliated Hospital,Suzhou University,Suzhou 215006,Jiangsu Province,China
  • Received:2015-08-31 Online:2016-05-10 Published:2016-05-20

摘要: 目的 探讨慢加急性肝衰竭前期(pre-ACLF)患者血清M30和M65水平在早期诊断慢加急性肝衰竭(ACLF)患者的价值。方法 采用ELISA法检测35例pre-ACLF患者(痊愈20例、进展15例)、40 例 HBV 相关ACLF 患者(生存20 例,死亡20例)、20例慢性乙型肝炎患者(CHB)和20例健康对照者血清M30和M65水平,分析其对pre-ACLF及ACLF患者临床转归的预测价值。结果 ACLF组和pre-ACLF组血清M30和M65水平均显著高于健康对照组或CHB患者,ACLF组显著高于pre-ACLF组(P<0.05);pre-ACLF进展组血清M30和M65[分别为(493.80±143.85)U/L和(712.47±305.67)U/L],与痊愈组[分别为(351.40±127.78)U/L和(448.15±165.14)U/L]比,差异具有统计学意义(P<0.05);pre-ACLF进展组与ACLF患者比,血清M30和M65水平[分别为(503.29±184.43)U/L和(746.99±275.19)U/L],均无显著性差异(P>0.05);以血清M30和M65水平鉴别诊断Pre-ACLF临床转归的ROC曲线下面积(AUC)分别为0.877和0.867;当M30≥453.70 U/L时,其预测预后的灵敏度和特异度分别为0.867和0.850;当M65≥626.71 U/L时,其早期预测ACLF的灵敏度和特异度分别为0.800 和 0.850。死亡的ACLF患者血清M30和M65水平虽高于ACLF好转组,但差异无统计学意义。结论 M30和M65是反应肝衰竭及肝衰竭前期患者肝细胞坏死或凋亡较敏感的指标,可用于早期诊断ACLF。

关键词: 慢加急性肝衰竭, 慢加急性肝衰竭前期, 早期诊断, M30抗原, M65抗原

Abstract: Objective To evaluate serum M30 and M65 levels in patients with acute-on-chronic pre-liver failure (pre-ACLF) and to investigate their value for early diagnosis of acute-on-chronic liver failure (ACLF). Methods Serum M30 and M65 levels in patients with pre-ACLF(n=35),ACLF(n=40),chronic hepatitis B (CHB,n=20) and healthy controls (n=20) were determined by enzyme-linked immunoabsorbent assay. The clinical significance for early diagnosis of ACLF was analyzed. Results Significantly higher serum M30 and M65 levels were found in patients with ACLF and with pre-ACLF compared with CHB or healthy controls(P<0.05);In pre-ACLF patients,serum M30 and M65 levels[(493.80±143.85)U/L and(712.47±305.67) U/L] were higher in 15 patients who progressed to ACLF than 20 recovered [(351.40±127.78)U/L and(448.15±165.14) U/L,respectively, P<0.05];No significant difference was found in serum M30 and M65 levels between 15 patients with pre-ACLF who switched to ACLF and 40 patients with ACLF(P>0.05);The area under receiver operating characteristic curve (AUC) demonstrated that both serum M30 and M65 had diagnostic value (AUC≥0.80) in identifying early ACLF from pre-ACLF patients(0.877 and 0.867,respectively);When serum M30 levels were ≥453.70 U/L,the sensitivity and specificity for diagnosis of ACLF was 0.867and 0.850,respectively,and when serum M65 levels were≥626.71 U/L,the sensitivity and specificity for diagnosis of ACLF was 0.800 and 0.850,respectively;No significant difference was found in serum M30 and M65 levels between 20 survived patients with ACLF as compared with 20 died (P>0.05). Conclusions In patients with pre-ACLF,serum M30 and M65 levels may serve as important biomarkers for early diagnosis of ACLF.

Key words: Acute-on-chronic liver failure, Acute-on-chronic pre-liver failure, Early diagnosis, M30, M65