摘要
目的探讨血清角蛋白18(CCK-18)、微小核糖核酸122(miR-122)、高迁移率组蛋白A2(HMGA2)在乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者中的表达意义及预后影响因素分析。方法回顾性分析2019年1月至2022年1月148例在我院确诊为HBV-ACLF患者的临床资料并纳入HBV-ACLF组,另选取150例在我院行一般体检的健康人作为对照组;对比两组受试者血清CCK-18、miR-122、HMGA2表达差异;Spearman分析CCK-18、miR-122、HMGA2表达与HBV-ACLF发病关系;接收者操作特征曲线(ROC)分析CCK-18、miR-122、HMGA2单独及联合检测对HBV-ACLF的诊断价值;另外对148例HBV-ACLF患者随访1年,截止2023年1月,按照随访结果分为预后良好组(n=86)及预后不良组(n=62),单因素、多因素分析影响HBV-ACLF患者预后不良的独立危险因素;ROC分析CCK-18、miR-122、HMGA2单独及联合检测对HBV-ACLF预后预测价值。结果相比于对照组,HBV-ACLF组患者的CCK-18水平显著降低,而miR-122、HMGA2表达水平显著升高(均P<0.05);Spearman相关系数分析显示,miR-122、HMGA2表达与HBV-ACLF发病之间呈显著正相关,而CCK-18与HBV-ACLF发病之间呈显著负相关(均P<0.05);ROC显示,联合检测的曲线下面积(AUC)显著高于单一指标检测,灵敏度为93.33%,特异性为89.19%;多因素回归分析后显示并发症增多、miR-122及HMGA2表达水平上升是引发HBV-ACLF患者预后不良的独立危险因素,而CCK-18是保护因素(均P<0.05);ROC显示联合检测对预测HBV-ACLF患者的AUC显著高于单一指标检测,灵敏度为90.32%,特异性为81.40%。结论HBV-ACLF患者血清CCK-18、miR-122、HMGA2均具有特异表达水平,且作为影响该类患者预后的独立危险因素提示不良结局的发生,联合检测对于诊断疾病及预测疾病预后均具有较高的临床价值。
Objective To investigate the expression significance of serum keratin 18(CCK-18),microRNA 122(miR-122),and high mobility histone A2(HMGA2)in patients with hepatitis B virus-associated slow plus acute liver failure(HBV-ACLF),and to analyze prognostic influencing factors.Methods The clinical data of 148 patients diagnosed with HBV-ACLF in our hospital from January,2019 to January,2022 were retrospectively analyzed and included in the HBV-ACLF group,and another 150 healthy individuals who underwent general physical examination in our hospital were selected as the control group;These two groups were compared for serum CCK-18,miR-122 and HMGA2 expressions;Spearman method was used to analyze the relationship between CCK-18,miR-122 and HMGA2 expression and the development of HBV-ACLF;ROC curve was drawn to evaluate the diagnostic value of CCK-18,miR-122 and HMGA2 alone or in combination for HBV-ACLF;In addition,148 patients with HBV-ACLF were followed up.HBV-ACLF patients were followed up for 1 year until January,2023,and were divided into the good prognosis group(n=86)and poor prognosis group(n=62)according to the follow-up results,and independent risk factors influencing poor prognosis of HBV-ACLF patients were analyzed with univariate and multifactor model;ROC curve was used to analyze CCK-18,miR-122,and HMGA2 alone or in combination for the prognostic value of HBV-ACLF prognostic predictive value.Results Compared with the control group,patients in the HBV-ACLF group had significantly lower levels of CCK-18 but significantly higher levels of miR-122 and HMGA2 expression(both P<0.05);Spearman’s correlation coefficient analysis showed a significant positive correlation between miR-122 and HMGA2 expression and the onset of HBV-ACLF,while CCK-18 and The ROC showed that the area under the curve of the combined test was significantly higher than that of the single-index test,with a sensitivity of 93.33%and specificity of 89.19%;Multivariate regression analysis showed that increased comorbidity,and increased levels of miR-122 and HMGA2 expression were independent risk factors for HBV-ACLF.ROC curve showed that the area under the curve of the combined test was significantly higher than that of the single-index test in predicting HBV-ACLF patients,with a sensitivity of 90.32%and a specificity of 81.40%.Conclusion Serum CCK-18,miR-122,and HMGA2 of HBV-ACLF patients have specific expression levels and can suggest adverse outcomes as independent risk factors affecting the prognosis.The combined assay has a high clinical value for diagnosing the disease and predicting disease prognosis.
作者
郭鸿雁
王蕊
刘庆峰
GUO Hongyan;WANG Rui;LIU Qingfeng(Clinic Center,Beijing You’an Hospital Affiliated to Capital Medical University,Beijing 100069,China;Department of Clinical Laboratory,Guang’anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)
出处
《标记免疫分析与临床》
CAS
2023年第6期907-913,共7页
Labeled Immunoassays and Clinical Medicine
基金
北京市科技计划课题(编号:Z1911000019084)。
