自身免疫性肝炎患者血清AAPR、LECT2和IL-21水平变化及其临床意义探讨*

doi:10.3969/j.issn.1672-5069.2026.05.010

摘要/Abstract

摘要： 目的探讨自身免疫性肝炎(AIH)患者血清白蛋白/碱性磷酸酶比值(AAPR)、白细胞衍生趋化因子2(LECT2)和白介素-21(IL-21)水平变化及其临床意义。方法 2023年5月～2025年5月我院收治的58例AIH患者,均接受标准的一线治疗方案,即泼尼松联合硫唑嘌呤治疗,采用ELISA法检测血清LECT2和IL-21水平,常规临床检测,计数AAPR。采用逐步回归法构建二元Logistic回归模型分析影响因素,应用受试者工作特征曲线(ROC)并计算曲线下面积(AUC)分析指标预测AIH患者治疗应答的效能。结果在本组58例AIH患者中,治疗6个月实现完全应答35例(60.3%),不完全应答23例(39.7%);不完全应答组血清LECT2、IL-21和IgG水平分别为(28.5±5.3)ng/mL、(263.5±25.6)pg/mL和(29.7±2.4)g/L,均显著高于完全应答组【分别为((20.4±4.1)ng/mL、(174.5±21.9)pg/mL和(23.1±2.1)g/L,P<0.05】,而AAPR为(0.3±0.1),显著低于完全应答组【(0.4±0.1),P<0.05】;二元Logistic回归分析显示,AAPR、血清IgG、LECT2和IL-21水平均为影响AIH患者治疗后不完全应答的危险因素(P<0.05);ROC分析显示,血清IgG联合AAPR、LECT2或IL-21中的任两项预测AIH患者治疗后不完全应答的AUC为0.891,虽然其敏感度为73.1%,但其特异度为97.1%。结论监测AIH患者血清AAPR、LECT2和IL-21水平变化可能对预测治疗应答有帮助,以及时调整治疗方案,提高应答率。

关键词: 自身免疫性肝炎, 标准免疫抑制治疗, 白蛋白, 碱性磷酸酶, 白细胞衍生趋化因子2, 白介素-21, 治疗

Abstract: Objective The aim of this study was to investigate implication of serum albumin/alkaline phosphatase ratio (AAPR) , leukocyte-derived chemokine 2 (LECT2) and interleukin-21 (IL-21) levels in patients with autoimmune hepatitis (AIH). Methods 58 patients with AIH were encountered in our hospital between May 2023 and May 2025, and all received standardized first-line treatment regimen, e.g., prednisone and azathioprine combination. Serum LECT2 and IL-21 levels were assayed by ELISA, and laboratory tests were obtained and AAPR was calculated. A binary Logistic regression model was constructed to analyze the risk factors influencing response to treatment, and receiver operating characteristic curve (ROC) was applied toevaluate predicting efficacy. Results By end of six month treatment, 35 patients(60.3%) obtained complete response (CR) and 23 patients(39.7%)didn’t; serum LECT2, IL-21 and IgG levels in patients with non-CR (NCR) were (28.5±5.3)ng/mL, (263.5±25.6)pg/mL and (29.7±2.4) g/L, all much higher than [((20.4±4.1)ng/mL, (174.5±21.9)pg/mL and (23.1±2.1)g/L, respectively, P<0.05], while AAPR was (0.3±0.1), much lower than [(0.4±0.1), P<0.05] in those with CR; binary Logistic regression analysis showed that AAPR, serum IgG, LECT2 and IL-21 levels were all the independent risk factors for incomplete response to immunosuppressive therapy(P<0.05); ROC analysis demonstrated that the AUC was 0.891, with relatively low sensitivity of 73.1%, but a relatively high specificity of 97.1%, when serum IgG level was combined with any two of serum AAPR, LECT2 or IL-21 levels in predicting response to immunosuppressive treatment. Conclusion Surveillance of serum AAPR, LECT2 and IL-21 level changes might help clinicians predict response to immunosuppressive therapy in patients with AIH, which warrants further clinical investigation.

Key words: Autoimmune hepatitis, Immunosuppressive therapy, Albumin, Alkaline phosphatase, Leukocyte-derived chemokine 2, Interleukin-21, Therapy

刘德军, 刘婧, 袁翊. 自身免疫性肝炎患者血清AAPR、LECT2和IL-21水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2026, 29(5): 677-680.

Liu Dejun, Liu Jing, Yuan Yi. Implication of serum AAPR,LECT2 and IL-21 levels in patients with autoimmune hepatitis[J]. Journal of Practical Hepatology, 2026, 29(5): 677-680.

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自身免疫性肝炎患者血清AAPR、LECT2和IL-21水平变化及其临床意义探讨^*

Implication of serum AAPR,LECT2 and IL-21 levels in patients with autoimmune hepatitis

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