摘要
目的探讨IL-32联合终末期肝病模型(MELD)对HBV相关慢加急性肝衰竭(HBV-ACLF)患者预后的预测价值。方法选取2015年1月-2018年12月在苏州大学附属第一医院住院的92例HBV-ACLF患者,根据确诊后3个月随访情况分为存活组(n=40)和死亡组(n=52)。采用酶联免疫吸附试验(ELISA)测定患者的血清IL-32水平。收集患者的临床资料,包括年龄、性别、合并基础疾病、主要并发症、WBC、PLT、红细胞比积(HCT)、TBil、ALT、AST、Alb、SCr、PT、INR、HBV DNA等。符合正态分布的计量资料2组间比较采用t检验,不符合正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ2检验;IL-32与其他变量进行Pearson相关性分析;采用二元logistic回归分析影响HBV-ACLF患者预后的独立危险因素;利用ROC曲线下面积(AUC)评价IL-32联合MELD评分对HBV-ACLF预后的预测价值,AUC的比较采用正态性Z检验。结果2组间HCT、PLT、TBil、SCr、PT、INR、HBV DNA、IL-32、MELD评分比较差异均有统计学意义(P值均<0.05);IL-32与TBil(r=0.952,P<0.001)、MELD评分(r=0.850,P<0.001)均呈显著正相关;IL-32(OR=1.137,95%CI:1.040~1.243,P=0.005)和MELD评分(OR=1.055,95%CI:1.001~1.109,P=0.025)是HBV-ACLF患者死亡的独立危险因素;IL-32联合MELD评分对HBV-ACLF患者预后的预测价值最高(AUC=0.992,95%CI:0.981~1.000),优于IL-32(AUC=0.984)和MELD评分(AUC=0.877),差异均具有统计学意义(Z值分别为2.265、3.182,P值均<0.05)。结论IL-32、MELD评分均能预测HBV-ACLF患者预后,两者联合则预测价值更高。
Objective To investigate the value of interleukin-32(IL-32)combined with Model for End-Stage Liver Disease(MELD)in predicting the prognosis of patients with hepatitis B virus(HBV)-related acute-on-chronic liver failure(HBV-ACLF).Methods A total of 92 patients with HBV-ACLF who were hospitalized in The First Affiliated Hospital of Soochow University from January 2015 to December 2018 were enrolled,and according to the follow-up results at 3 months after diagnosis,the patients were divided into survival group with 40 patients and death group with 52 patients.ELISA was used to measure the serum level of IL-32.Clinical data of the patients were collected,including age,sex,underlying diseases,major complications,white blood cell count(WBC),platelet count(PLT),hematocrit(HCT),total bilirubin(TBil),alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(Alb),serum creatinine(SCr),prothrombin time(PT),international normalized ratio(INR),and HBV DNA.The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups;a Pearson correlation analysis was performed for IL-32 and other variables;a binary logistic regression analysis was performed to investigate the independent risk factors for the prognosis of patients with HBV-ACLF.The receiver operating characteristic(ROC)curve(AUC)was used to evaluate the value of IL-32 combined with MELD score in predicting the prognosis of patients with HBV-ACLF.The normal Z test was used for comparison of AUC.Results There were significant differences between the two groups in HCT,PLT,TBil,SCr,PT,INR,HBV DNA,IL-32,and MELD score(all P<0.05).IL-32 was positively correlated with TBil(r=0.952,P<0.001)and MELD score(r=0.850,P<0.001).IL-32(odds ratio[OR]=1.137,95%confidence interval[CI]:1.040-1.243,P=0.005)and MELD score(OR=1.055,95%CI:1.001-1.109,P=0.025)were independent risk factors for the death of HBV-ACLF patients.IL-32 combined with MELD score had the highest value in predicting the prognosis of patients with HBV-ACLF(AUC=0.992,95%CI:0.981-1.000),with a significantly higher AUC than IL-32(0.992 vs 0.984,Z=2.265,P<0.05)and MELD score(0.992 vs 0.877,Z=3.182,P<0.05).Conclusion Both IL-32 and MELD score can predict the prognosis of patients with HBV-ACLF,and the combination of these two indicators has a better predictive value.
作者
顾静
王艳
孙蔚
赵卫峰
甘建和
GU Jing;WANG Yan;SUN Wei;ZHAO Weifeng;GAN Jianhe(Department of Infectious Diseases,The First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215006,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2021年第2期304-308,共5页
Journal of Clinical Hepatology
基金
国家科技部“十三五”重大专项(2017ZX10203201002-002)。
