Abstract: Objective The purpose of this study was to investigate changes of serum angiopoietin-like protein 2 (ANGPTL2), soluble vascular adhesion protein 1 (sVAP-1) and high mobility group box protein 1 (HMGB1) levels in patients with hepatitis B virus infection-related acute-on-chronic liver failure (HBV-ACLF). Methods 67 patients with HBV-ACLF (early stage in 21 cases, moderate stage in 26 and terminal stage in 20 cases), 60 patients with chronic hepatitis B (CHB) and 60 healthy individuals for physical examination were enrolled in our hospital between December 2021 and February 2024, and serum ANGPTL2, sVAP-1 and HMGB1 levels were assayed by ELISA. Model for end-stage liver disease (MELD) scores were routinely calculated. Linear correlation was applied for correlation analysis. Results Serum ANGPTL2, sVAP-1 and HMGB1 levels in patients with HBV-ACLF were (11.1±2.6) ng/mL, (848.5±237.6) ng/mL and (68.7±15.9) ng/mL, all significantly higher than [(9.3±2.0) ng/mL, (702.3±208.8) ng/mL and (58.8±12.1) ng/mL, respectively,P<0.05] in patients with CHB or [(4.6±1.2) ng/mL, (425.3±103.4) ng/mL and (38.8±8.1) ng/mL, respectively, P＜0.05] in healthy control; serum ANGPTL2,sVAP-1 and HMGB1 levels in patients with ACLF at terminal stage were all much higher than in those at moderate or early stages (P＜0.05); serum ANGPTL2,sVAP-1 and HMGB1 levels in patients with HBV-ACLF were positively correlated to MELD scores(P＜0.05), and they were significantly higher in 30 dead patients than in 37 survivals(P＜0.05). Conclusion Serum ANGPTL2, sVAP-1 and HMGB1 levels in patients with HBV-ACLF elevates greatly, which might be related to severity of the entity. Clinicians should put emphasis on surveillance of serum ANGPTL2, sVAP-1and HMGB1, and pay more attention to patients with increased serum markers.

Key words: Acute-on-chronic liver failure, Angiopoietin-like protein 2, Vascular adhesion protein 1, High mobility group box protein 1, Prognosis