实用肝脏病杂志 ›› 2023, Vol. 26 ›› Issue (6): 847-850.doi: 10.3969/j.issn.1672-5069.2023.06.020

• 肝衰竭 • 上一篇    下一篇

HBV相关慢加急性肝衰竭患者血清GP73、suPAR和AT-Ⅲ水平变化及其临床意义探讨*

李菲, 陈辛未, 李琦   

  1. 075000 河北省张家口市 河北北方学院附属第一医院输血科(李菲,陈辛未);血液病科(李琦)
  • 收稿日期:2023-03-07 出版日期:2023-11-10 发布日期:2023-11-20
  • 作者简介:李菲,女,32岁,大学本科,初级检验师。E-mail:a1637553572@126.com
  • 基金资助:
    * 河北省科技厅医学科学研究项目(编号:20200505)

Prediction of short-term survival by serum GP73, suPAR and AT-III levels in patients with HBV-related acute-on-chronic liver failure

Li Fei, Chen Xinwei, Li Qi   

  1. Department of Blood Transfusion, First Affiliated Hospital, Hebei North University, Zhangjiakou 075000, Hebei Province, China
  • Received:2023-03-07 Online:2023-11-10 Published:2023-11-20

摘要: 目的 探讨乙型肝炎病毒相关性慢加急性肝衰竭(HBV-ACLF)患者血清高尔基体蛋白73(GP73)、可溶性人尿激酶型纤溶酶原激活物受体(suPAR)和抗凝血酶-Ⅲ(AT-Ⅲ)水平变化及其临床意义。方法 2019年11月~2022年10月我院收治的HBV-ACLF患者81例(早期29例,中期28例,晚期24例)和慢性乙型肝炎(CHB)患者65例,采用ELISA法检测血清GP73、suPAR和AT-Ⅲ水平。应用受试者工作特征曲线(ROC)评估各指标评估疾病预后的价值。结果 HBV-ACLF患者血清GP73和suPAR水平分别为(227.4±48.4)ng/mL和(8.3±2.3)ng/mL,显著高于CHB患者【分别为(126.6±31.6)ng/mL和(5.1±1.6)ng/mL,P<0.05】,而血清AT-Ⅲ水平为(48.2±12.9)%,显著低于CHB患者【(76.6±18.7)%,P<0.05】;晚期HBV-ACLF患者血清GP73和suPAR水平分别为(265.6±27.1)ng/mL和(9.4±1.2)ng/mL,显著高于中期患者【分别为(231.7±29.5)ng/mL和(8.4±1.4)ng/mL,P<0.05】或早期患者【分别为(191.6±33.5)ng/mL和(7.3±1.6)ng/mL,P<0.05】,而血清AT-Ⅲ水平为(36.8±9.1)%,显著低于中期患者【(47.1±10.9)%,P<0.05】或早期患者【58.7±11.3)%,P<0.05】;在治疗3个月末,本组ACLF患者生存59例(72.8%),死亡22例(27.2%);死亡组血清GP73和suPAR水平分别为(270.4±38.3)ng/mL和(9.9±6.2)ng/mL,显著高于生存组【分别为(210.9±41.5)ng/mL和(8.0±1.5)ng/mL,P<0.05】,而血清AT-Ⅲ水平为(35.4±9.1)%,显著低于生存组【(51.1±10.6)%,P<0.05】;联合检测HBV-ACLF患者血清GP73、suPAR和AT-Ⅲ水平预测短期死亡的AUC为0.846,显著优于三项指标单独评估(其AUC分别为0.703、0.710和0.744,P<0.05),其灵敏度、特异度和准确度分别为81.8%、81.4%和81.5%。结论 监测HBV-ACLF患者血清GP73、suPAR和AT-Ⅲ水平可能有助于评估预后,值得进一步研究。

关键词: 慢加急性肝衰竭, 高尔基体蛋白73, 可溶性人尿激酶型纤溶酶原激活物受体, 抗凝血酶-Ⅲ, 预后

Abstract: Objective The aim of this study was to explore the changes of Golgi protein 73 (GP73), soluble urokinase plasminogen activator receptor (suPAR) and antithrombin-III (AT-III) levels in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods 81 patients with HBV-ACLF, including 29 cases at early stage, 28 cases at middle stage and 24 cases at advanced stage, and 65 patients with chronic hepatitis B (CHB), matched by gender and age, were enrolled in our hospital between November 2019 and October 2022. Serum GP73, suPAR and AT-III levels were detected by ELISA. The patients with HBV-ACLF were carefully managed and followed-up for 3 months. The predicting performance was evaluated by the area under the receiver operating characteristic (ROC) curves. Results Serum GP73 and suPAR levels in patients with HBV-ACLF were(227.4±48.4)ng/mL and (8.3±2.3)ng/mL, much higher than [(126.6±31.6)ng/mL and (5.1±1.6)ng/mL, respectively, P<0.05], while serum AT-Ⅲ level was (48.2±12.9)%, much lower than [(76.6±18.7)%, P<0.05] in patients with CHB; serum GP73 and suPAR levels in patients with advanced HBV-ACLF were (265.6±27.1)ng/mL and (9.4±1.2)ng/mL, significantly higher than [(231.7±29.5)ng/mL and (8.4±1.4)ng/mL, P<0.05] in patients at middle stage or [(191.6±33.5)ng/mL and (7.3±1.6)ng/mL, P<0.05] in patients at early stage, while serum AT-Ⅲ level was (36.8±9.1)%, significantly lower than [(47.1±10.9)%, P<0.05] in patients at middle stage or [58.7±11.3)%, P<0.05] in patients at early stage; at the end of three month treatment, 59 patients(72.8%) survived and 22 patients (27.2%) died in our series; serum GP73 and suPAR levels in dead patients at admission were (270.4±38.3)ng/mL and (9.9±6.2)ng/mL, significantly higher than [(210.9±41.5)ng/mL and (8.0±1.5)ng/mL, P<0.05], while serum AT-Ⅲ level was (35.4±9.1)%, significantly lower than [(51.1±10.6)%, P<0.05] in survivals; the AUC was 0.846 by the three combination in predicting the prognosis, much superior to the three parameters alone (the AUCs were 0.703, 0.710 and 0.744, P<0.05), with the sensitivity of 81.8%, the specificity of 81.4%, and the accuracy of 81.5%. Conclusion The surveillance of serum GP73, suPAR and AT-III levels might help predict the prognosis of patients with HBV-ACLF, and warrants further clinical investigation.

Key words: Acute-on-chronic liver failure, Golgi protein 73, Soluble urokinase plasminogen activator receptor, Antithrombin-III, Prognosis