摘要
目的探讨血浆髓样细胞触发受体2(TREM-2)联合终末期肝病模型(MELD)评分对乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者近期预后的预测价值。方法选取2019年1月-2021年1月我院收治的142例HBV-ACLF患者为HBV-ACLF组,随访90 d根据患者结局分为死亡组(n=52)和存活组(n=90),另选取同期58名体检健康者为对照组。ELISA法检测血浆白介素-6(IL-6)、白介素-8(IL-8)、髓样细胞触发受体2(TREM-2)水平,计算HBV-ACLF患者MELD评分。分析HBV-ACLF患者血浆TREM-2与IL-6、IL-8水平的相关性。多因素logistic回归分析HBV-ACLF患者近期预后不良影响因素。ROC曲线分析血浆TREM-2水平联合MELD评分对HBV-ACLF患者近期预后的预测价值。结果与对照组比较,HBVACLF组血浆IL-6,IL-8,TREM-2水平升高(P<0.05)。HBV-ACLF患者血浆TREM-2与IL-6,IL-8水平呈正相关(r/rs=0.762、0.857,均P<0.001)。中性粒细胞比值、总胆红素、血肌酐、国际标准化比值、MELD评分、IL-6、IL-8、TREM-2为HBV-ACLF患者近期预后不良的独立危险因素(P<0.05)。TREM-2、MELD评分、TREM-2+MELD评分预测HBV-ACLF患者近期预后的曲线下面积分别为0.771、0.795、0.858,TREM-2+MELD评分预测HBV-ACLF患者近期预后的曲线下面积大于TREM-2,MELD评分单独预测(P<0.05)。结论血浆TREM-2水平和MELD评分升高为HBV-ACLF患者近期预后不良的独立危险因素,血浆TREM-2联合MELD评分能提升HBV-ACLF患者近期预后不良的预测价值。
Objective To investigate the energy efficiency of plasma triggering receptor expressed on myeloid cell 2(TREM-2)combined with model for end-stage liver disease(MELD)score in predicting the near-term prognosis of patients with hepatitis B virus-acute-on-chronic liver failure(HBV-ACLF).Methods A total of 142patients with HBV-ACLF admitted to our hospital from January 2019 to January 2021 were selected as the HBVACLF group,and were divided into a death group(n=52)and a survival group(n=90)according to patient outcomes at 90 d follow-up,and another 58 physically healthy individuals were selected as the control group during the same period.Plasma interleukin-6(IL-6),IL8,and TREM-2 levels were measured by ELISA and MELD scores were calculated.Pearson/Spearman correlation coefficient was used to analyze the correlation between plasma TREM-2 and the levels of IL-6 and IL-8 in HBV-ACLF patients.Multivariate logistic regression was used to analyze factors influencing the poor prognosis of HBV-ACLF patients in the near future.The predictive value of plasma TREM-2 levels combined with the MELD score for the near-term prognosis of HBV-ACLF patients was analyzed using ROC curves.Results Plasma IL-6,IL-8 and TREM-2 levels were significantly elevated in the HBV-ACLF group compared to the control group(P<0.05).Plasma TREM-2 was positively correlated with the levels of IL-6and IL-8 in HBV-ACLF patients(r/rs=0.762,0.857,all P<0.001).Neutrophil ratio,total bilirubin,blood creatinine,international normalized ratio,MELD score,IL-6,IL-8 and TREM-2 were independent risk factors for poor prognosis of the HBV-ACLF patients in the near future(P<0.05).The areas under the curve for the TREM-2,MELD score,and TREM-2+MELD score predicting the near-term prognosis of the HBV-ACLF patients were0.771,0.795,and 0.858,respectively,and the area under the curve for the TREM-2+MELD score predicting the near-term prognosis of HBV-ACLF patients was significantly greater than that predicted by the TREM-2,MELD score alone(P<0.05).Conclusion Plasma TREM-2 levels and elevated MELD scores are independent risk factors for poor prognosis of HBV-ACLF patients in the near future,and plasma TREM-2 combined with MELD scores enhances the predictive value of poor prognosis of the patients in the near future.
作者
柳梅
亓敏
丁雷
郇娟
韩永峰
LIU Mei;QI Min;DING Lei;YING Juan;HAN Yongfen(Infectious Disease Department,Jinan People′s Hospital,Shandong First Medical University,Ji’nan 271100,China)
出处
《实用医学杂志》
CAS
北大核心
2022年第4期473-478,共6页
The Journal of Practical Medicine
基金
山东省医药卫生科技发展计划(编号:2018WS109)。
关键词
乙型肝炎病毒
慢加急性肝衰竭
髓样细胞触发受体2
终末期肝病模型
预后
hepatitis B virus
acute-on-chronic liver failure
triggering receptor expressed on myeloid cell 2
model for dnd-stage liver disease
prognosis
