HBV-ACLF患者血清FT3水平变化及其临床意义探讨*

doi:10.3969/j.issn.1672-5069.2022.02.022

摘要/Abstract

摘要： 目的探索应用游离三碘甲状腺原氨酸(FT3)水平预测乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者病情严重程度的价值。方法纳入2018年9月～2020年2月我院住院的HBV-ACLF患者122例,使用雅培 i2000SR 全自动化学发光分析仪检测血清FT3水平。应用受试者工作特征曲线下面积(AUROC)分析血清FT3水平预测MELD评分的效能。结果 45例肝衰竭早期、46例中期和31例晚期患者血清FT3水平分别为(2.73±0.57)pmol/L、(2.55±0.49)pmol/L和(2.29±0.42)pmol/L,组间差异显著(P < 0.001);MELD<30、30≤MELD<40、MELD≥40组血清FT3水平分别为(2.77±0.14)pmol/L、(2.32±0.13)pmol/L和(2.08±0.09)pmol/L(P < 0.001),提示随着衰竭器官数量的逐渐增多或MELD评分升高,血清FT3水平逐渐降低;经ROC曲线分析,结果显示FT3(1-AUROC)为0.739(0.686～0.792),而Ln(TBIL)、Ln(Cr)和Ln(INR)的AUROC分别为[0.748(0.696～0.800)、0.632(0.562～0.702)和0.933(0.903～0.963),P<0.001],提示血清FT3预测MELD评分高的效能仅次于INR,而与血清总胆红素相当。结论应用血清FT3水平预测HBV-ACLF患者病情严重程度具有一定的临床意义,血清FT3水平太低意味着病情严重。

关键词: 慢加急性肝衰竭, 游离三碘甲状腺原氨酸, 终末期肝病模型, 预测

Abstract: Objective The aim of this study was to investigate the implication of serum free triiodothyronine (FT3) in patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF). Methods 122 patients with HBV-ACLF were admitted in Beijing You'an Hospital between September 2018 and February 2020, and serum FT3 levels were detected. The area under the receiver operating characteristic curve (AUROC) was applied to analyze the efficacy of serum FT3 for predicting the model for end-stage liver disease (MELD) score. Result Serum FT3 levels in 45 patients with HBV-ACLF early stage, in 46 patients with middle stage and in 31 patients with late stage were (2.73±0.57)pmol/L,(2.55±0.49)pmol/L and (2.29±0.42)pmol/L, significantly different among them(P < 0.001); serum FT3 levels in patients with MELD<30, 30≤MELD<40 and MELD≥40 were (2.77±0.14)pmol/L, (2.32±0.13)pmol/L and (2.08±0.09)pmol/L(P < 0.001), suggesting the tends of increased MELD score as serum FT3 levels gradually decreased; the ROC analysis showed that the 1-AUROC of serum FT3 was 0.739(0.686-0.792), while the 1-AUROCs of total serum bilirubin (TSB) levels, of serum creatinine and international normalized ratio (INR) of prothrombin time were [0.748(0.696-0.800), 0.632(0.562-0.702) and 0.933(0.903-0.963), respectively, P<0.001], suggesting that the efficacy of serum FT3 levels was equal to TSB. Conclusion Serum FT3 levels decrease in patients with HBV-ACLF, which might be a new indicator to judge the severity of the disease.

Key words: Acute-on-chronic liver failure, Free triiodothyronine, Model for end-stage liver disease, Prediction

张剑, 陈煜, 段钟平. HBV-ACLF患者血清FT3水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2022, 25(2): 239-242.

Zhang Jian, Chen Yu, Duan Zhongping. Serum FT3 level changes in patients with HBV-ACLF[J]. Journal of Practical Hepatology, 2022, 25(2): 239-242.

参考文献

[1] 中华医学会感染病学分会肝衰竭与人工肝学组;中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2018年版).实用肝脏病杂志,2019,22(2):164-171.
[2] 苏亚勇,徐成润,郭永木,等.慢加急性乙型肝炎肝衰竭患者死亡危险因素和预后评分模型的构建.实用肝脏病杂志, 2021,24(3):391-394.
[3] Piantanida E, Ippolito S, Gallo D, et al. The interplay between thyroid and liver : Implications for clinical practice. J Endocrinol Invest, 2020,43(7):885-899.
[3] Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatol Int, 2001,33(2):464-470.
[4] Richard M, Rajiv J, Pere G, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology, 2013,144(7):1426-1437.
[5] Piantanida E, Ippolito S, Gallo D, et al. The interplay between thyroid and liver : Implications for clinical practice. Endocrinol Invest, 2020,43(7):885-899.
[6] Belei AT, Cordoba J. Practice parameters committee of the American college of gastroenterology. Am J Gastroenterol, 2001,96(7):1968-1976.
[7] Chang ML, Liaw YF. Hepatitis B flares in chronic hepatitis B: Pathogenesis, natural course, and management. J Hepatol, 2014,61(6):1407-1417.
[8] Angeli P, Gines P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis : Revised consensus recommendations of the international club of asites, J Hepatol, 2015,62(4):968-974.
[9] 中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版). 中华外科杂志, 2019,57(12):885-892.
[10] 中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南. 中华肝脏病杂志, 2017,25(9):664-677.
[11] 中华医学会肝病学分会药物性肝病学组. 药物性肝损伤诊治指南. 实用肝脏病杂志, 2017,20(2):1-18.
[12] Shannon MF, Bram R, Andrew JE. Clinical implications of the third international consensus definitions for sepsis and septic shock(sepsis-3).CMAJ, 2018, 190(36): E1058-E1059.
[13] 中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016年版). 中华结核和呼吸杂志, 2016,39(4):253-279.
[14] Sun L, Alan PF. Euthyroid sick syndrome. Compr Physiol, 2016,6(2):1071-1080.
[15] Punekar P, Sharma AK, Jain A. A study of thyroid dysfunction in cirrhosis of liver and correlation with severity of liver disease. Indian J Endocrinol Metab, 2018,22(5):645-650.
[16] Sarin SK, Choudhury A, Sharma MK, et al. Acute-on-chronic liver failure : consensus recommendations of the Asian pacific association for the study of the liver (APASL) : an update. Hepatol Int, 2019,13(4):353-390.
[17] Gao XY, Guo CH, Zhu W, et al. Study on the abnormal thyroiberin and related factors in patients with acute hepatic failure related encephpathy of type a hepatitis and its related in fluencing factors. J Clin Exp Med, 2019,18(3):274-277.
[18] Chen DJ, Zhu MG, Liu LL ,et al. The impact of hypothyroidism on the incidence and clinical prognosis of acute kidney injury in critically ill patients. J Clin Nephrol, 2019,19(12):907-911.
[19] Qian L, Jun W, Meng JL, et al. Acute-on-chronic liver failure from chronic hepatitis B, Who is the behind scenes. Front Microbiol, 2020,11:583423.
[20] De Luca R, Davis PJ, Lin H-Y, et al. Thyroid hormones interaction with immune response, inflammation and non-thyroidal illness syndrome. Front Cell Develop Biol, 2021,8:641030.
[21] Wu T, Li J, Shao L, et al. Development of diagnostic criteria and prognostic score for hepatitis b virus related acute-on-chronic liver failure.Gut, 2018,67(12):2181-2191.
[22] Jalan R, Saliba F, Pavesim M, et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. Hepatology, 2014,61(5):1038-1047.

HBV-ACLF患者血清FT3水平变化及其临床意义探讨^*

Serum FT3 level changes in patients with HBV-ACLF

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	严景全, 王春玲, 刘娟, 卢雪兰, 林占洲, 莫凡. 血清乙型肝炎病毒前基因组RNA水平对核苷(酸)类似物初治的慢性乙型肝炎患者疗效预测价值^*[J]. 实用肝脏病杂志, 2022, 25(1): 22-25.
[2]	刘积庆, 于国英, 杨生森, 黄群, 保成兰. 多种预后评分系统预测慢加急性肝衰竭并发真菌感染患者短期预后价值分析^*[J]. 实用肝脏病杂志, 2021, 24(6): 851-854.
[3]	董金玲, 李璐, 陈煜. 缓慢持续型慢加急性肝衰竭与慢性肝衰竭的甄别^*[J]. 实用肝脏病杂志, 2021, 24(5): 611-612.
[4]	刘玉玲, 甄增国, 王慧娟, 万秀敏, 杨爽. 血清-腹水白蛋白梯度对失代偿期乙型肝炎肝硬化患者发生EVB风险的预测价值^*[J]. 实用肝脏病杂志, 2021, 24(5): 637-640.
[5]	陈丹丹, 龙志达, 黄顺东, 王文虎, 尹明红, 李忠斌. 慢加急性乙型肝炎肝衰竭患者发生感染和急性肾损伤危险因素分析^*[J]. 实用肝脏病杂志, 2021, 24(5): 717-720.
[6]	黄霜湘, 姚朝光, 蓝婧, 欧琴, 覃冬林, 陈丽芬, 黄洁婕. 慢加急性乙型肝炎肝衰竭患者血清自噬相关蛋白水平及其临床意义探讨^*[J]. 实用肝脏病杂志, 2021, 24(5): 721-724.
[7]	鲁小龙, 解春宝. IL-6基因多态性对HBV相关ACLF患者短期预后的影响[J]. 实用肝脏病杂志, 2021, 24(4): 516-519.
[8]	利振坤, 何吕芬, 李欢, 符晓莹, 王身华, 吴智明. 慢加急性肝衰竭并发侵袭性真菌感染患者临床特点及其影响因素分析[J]. 实用肝脏病杂志, 2021, 24(4): 520-523.
[9]	孔雪杰, 李江, 李昊天, 李绪桐, 郜玉峰. 不同肝病基础的慢加急性肝衰竭患者临床特征和预后评分模型预测效能比较[J]. 实用肝脏病杂志, 2021, 24(3): 387-390.
[10]	苏亚勇, 徐成润, 郭永木, 张惠勇, 刘双平, 陈小兰. 慢加急性乙型肝炎肝衰竭患者死亡危险因素和预后评分模型的构建[J]. 实用肝脏病杂志, 2021, 24(3): 391-394.
[11]	张雪, 胥莹, 安文慧, 张帮婷, 杨雪芳. 五种评分系统判断TACE术治疗原发性肝癌患者发生肝功能不全效能比较研究[J]. 实用肝脏病杂志, 2021, 24(1): 111-114.
[12]	关万涛, 康福新, 林维, 林宏云, 黎仕焕. CRRT联合PE治疗慢加急性乙型肝炎肝衰竭并发急性肾损伤患者疗效研究^*[J]. 实用肝脏病杂志, 2020, 23(6): 833-836.
[13]	王培, 张青, 李颍, 颜学兵, 丁芹. 基于红细胞分布宽度和中性粒细胞/淋巴细胞比值建立慢加急性乙型肝炎肝衰竭患者短期预后预测模型价值研究[J]. 实用肝脏病杂志, 2020, 23(5): 682-686.
[14]	李侗曾, 孔明, 宋文艳, 徐曼曼, 陈煜, 全国疑难及重症肝病攻关协作组. 慢加急性肝衰竭患者第三腰椎骨骼肌指数与临床指标的关系^*[J]. 实用肝脏病杂志, 2020, 23(4): 467-470.
[15]	陈曦, 陈照林, 董静, 宋海燕, 刘波, 张骏飞, 陈从新. 脐带间充质干细胞联合双重血浆分子吸附治疗慢加急性肝衰竭患者临床效果初步观察[J]. 实用肝脏病杂志, 2020, 23(4): 544-547.