关键词: 慢加急性肝衰竭, 无翅型MMTV整合位点5a, 微血管相关蛋白1轻链3-Ⅱ, 终末期肝病模型评分, 预后, 预测

Abstract: Objective The aim of this study was to explore the predictive efficacy of serum wingless-type MMTV integration site family member 5a (wnt5a) and microtubule-associated protein 1 light chain 3 II (LC3-II) levels and the model of end-stage liver disease (MELD) score for short-term prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods A total of 152 patients with HBV-ACLF were encountered in our hospital between January 2018 and December 2022, and all patients were routinely carefully managed for supporting and anti-viral treatment. The MELD scores were calculated, and serum serum wnt5a and LC3-II levels were detected by ELISA. The influencing factors of short-term prognosis in patients with HBV-ACLF were analyzed by the Logistic regression analysis, and the predictive performance was evaluated by the receiver operating characteristic (ROC) curves. Results At the end of three month treatment, 112 patients survived of liver failure and 40 (26.3%)patients died; the age, incidence of hepatic encephalopathy (HE), INR, total serum bilirubin level, MELD score and serum wnt5a level in dead patients were (51.3±5.1)yr, 70.0%, (3.2±0.9), (441.5±89.7)μmol/L, (28.2±4.3) and (2.8±1.5)ng/mL, all significantly higher or greater than [(45.4±4.6)yr, 20.0%, (1.7±0.3), (280.6±73.1)μmol/L, (19.7±2.8) and (1.3±0.2)ng/mL, respectively, P＜0.05], while blood platelet count and serum LC3-Ⅱ level were (77.8±10.3)×10⁹/L and (20.6±2.1)μg/mL, both significantly lower than [(116.4±11.7)×10⁹/L and (32.5±3.9)μg/mL, respectively, P＜0.05] in the survivals; the multivariate Logistic regression analysis showed that the age, HE, elevated serum wnt5a level or reduced serum LC3-Ⅱ level were all the factors impacting the short-term prognosis (P＜0.05); the sensitivity and the specificity were 80.0% and 92.9%, respectively when the MELD score greater than 26.9 was set as the cut-off-value in predicting the short-term prognosis in patients with HBV-ACLF, and the detection of serum wnt5a and LC3-Ⅱ levels could improve the prediction. Conclusion The combination of serum wnt5a and LC3-II levels and MELD score is efficacious in predicting the short-term prognosis of patients with HBV-ACLF.

Key words: Acute-on-chronic liver failure, Wingless-type MMTV integration site family member 5a, Microtubule-associated protein 1 light chain 3 II, Model of end-stage liver disease, Prognosis, Prediction