血清PTX3和sTWEAK预测失代偿期乙型肝炎肝硬化患者死亡临床价值分析

doi:10.3969/j.issn.1672-5069.2021.02.022

摘要/Abstract

摘要： 目的检测失代偿期乙型肝炎肝硬化患者血清正五聚蛋白3(PTX3)和人可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)水平,并分析其预测失代偿期乙型肝炎肝硬化患者死亡的临床价值。方法 2016年1月～2019年6月我院肝病科收治的失代偿期乙型肝炎肝硬化患者108例,随访6个月。采用化学发光免疫分析法测定血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和C反应蛋白(CRP)水平,采用ELISA法测定血清PTX3和sTWEAK水平。应用Logistic回归分析失代偿期乙型肝炎肝硬化患者死亡的危险因素,应用受试者工作特征曲线(ROC)评估血清PTX3和sTWEAK水平预测死亡的效能。结果在随访期间,本组患者生存69例,死亡39例;死亡组患者血清TNF-α、IL-6、CRP、PTX3和sTWEAK水平显著高于生存组[分别为(68.3±11.2)ng/L对(39.8±19.0)ng/L,(918.3±148.7)ng/L对 (249.6±51.2)ng/L,(5.6±0.3)mg/L 对(2.4±0.9)mg/L,(19.7±3.3)ng/mL对 (11.6±0.6)ng/mL和(1459.0±215.3)ng/L 对 (549.5±23.5)ng/L,P<0.05],而死亡组患者SGNA评分显著低于生存组[(16.5±8.6)分对(23.2±7.6)分,P<0.05];多因素分析表明SGNA及血清PTX3和sTWEAK水平是影响失代偿期乙型肝炎肝硬化患者死亡的独立危险因素(分别为OR=1.366、95%CI:1.036~1.801;OR=1.939、95%CI:1.409~2.670和OR=2.891、95%CI:1.909~4.380,P<0.05);SGNA及血清PTX3和sTWEAK水平对失代偿期乙型肝炎肝硬化患者死亡均具有预测价值,三组比较,显示PTX3的AUC最大(AUC=0.868、95%CI:0.823~0.912),sTWEAK次之(AUC=0.753、95%CI:0.690~0.816),而SGNA的最小(AUC=0.675、95%CI:0.606~0.743),血清PTX3水平预测死亡的灵敏度和特异度均最高,分别为83.52%和74.16%。结论失代偿期乙型肝炎肝硬化死亡患者血清PTX3和sTWEAK水平显著升高,检测其水平有助于早期预测失代偿期乙型肝炎肝硬化患者预后,值得临床进一步研究。

关键词: 肝硬化, 正五聚蛋白3, 人可溶性肿瘤坏死因子样凋亡弱诱导因子, 预后

Abstract: Objective The aim of this study was to investigate the clinical value of serum pentraxin 3 (PTX3) and soluble tumor necrosis factor-like weak inducer of apoptosis (TWEAK) levels in predicting death of patients with decompensated hepatitis B cirrhosis.Methods 108 patients with decompensated hepatitis B-induced liver cirrhosis were admitted to our hospital between January 2016 and June 2019, and all were followed-up for 6 months. The protein-energy wasting (PEW) was evaluated, and serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) as well as serum PTX3 and sTWEAK levels were detected.Results 39 patients with decompensated hepatitis B-induced liver cirrhosis out of our series died, and 69 survived during six month follow-up period; serum TNF-α, IL-6, CRP, PTX3 and sTWEAK levels in dead group at presentation were significantly higher than those in the survival group[(68.3±11.2)ng/L vs. (39.8±19.0)ng/L, (918.3±148.7)ng/L vs. (249.6±51.2)ng/L, (5.6±0.3)mg/L vs. (2.4±0.9)mg/L, (19.7±3.3)ng/mL vs. (11.6±0.6)ng/mL, and (1459.0±215.3)ng/L vs. (549.5±23.5)ng/L, respectively, all P<0.05], while the SGNA score in the dead group was significantly lower than that in the survival group[(16.5±8.6) vs. (23.2±7.6), P<0.05]; the multivariate Logistic analysis showed that the SGNA, serum PTX3 and sTWEAK levels were the independent risk factors for death in patients with decompensated hepatitis B cirrhosis (OR=1.366, 95%CI:1.036-1.801; OR=1.939, 95%CI:1.409-2.670, OR=2.891; 95%CI:1.909-4.380, P<0.05); the SGNA, serum PTX3 and sTWEAK levels had predictive value for the death of patients with decompensated hepatitis B cirrhosis with the area under ROC (AUC) of serum PTX3 level the largest(AUC=0.868, 95%CI:0.823-0.912), of serum sTWEAK the relative large(AUC=0.753, 95%CI:0.690-0.816)and the SGNA smallest (AUC=0.675, 95%CI:0.606-0.743), and the sensitivity and specificity of serum PTX3 level were the highest, 83.52% and 74.16%, respectively.Conclusion Serum levels of PTX3 and sTWEAK in dead patients with decompensated cirrhosis elevate early, and the determination of them might help predict the prognosis of patients with decompensated hepatitis B cirrhosis in the early stage, which is worthy of clinical verification.

Key words: Liver cirrhosis, Pentraxin 3, Soluble tumor necrosis factor-like weak inducer of apoptosis, Prognosis

王江丽, 裴凌燕, 贺晶晶, 李岚, 袁佳健, 夏莉婷, 崔雯. 血清PTX3和sTWEAK预测失代偿期乙型肝炎肝硬化患者死亡临床价值分析[J]. 实用肝脏病杂志, 2021, 24(2): 236-239.

Wang Jiangli, Pei Lingyan, He Jingjing, et al. Clinical value of serum PTX3 and sTWEAK in predicting death of patients with decompensated hepatitis B cirrhosis[J]. Journal of Practical Hepatology, 2021, 24(2): 236-239.

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