Objective To investigate the predictive value of dynamic changes of interferon-inducible protein-10 (IP-10) expression in the peripheral blood mononuclear cells and the model for end-stage 1iver disease (MELD) scores for short-term mortality in hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) patients .Methods Eighty patients with HBV-ACLF admitted to the Affiliated Hospital of Hubei College of Arts and Sciences from October 2013 to August 2015 were selected .During 3 months of follow-up ,33 patients died and 47 survived .The expression level of IP-10 and MELD score of two groups were measured at admission and week 1 and week 2 after treatment .The means between two groups were compared .Accuracy of predicting short-term mortality was performed by area under receiver operating characteristic curve (AUC) .Multivariate logistic regression analysis and Kaplan-Meier survival curve were used to analyze the effect of IP-10 expression and MELD score on the mortality of HBV-ACLF patients . Results The expressions of IP-10 at admission and at week 1 and 2 after treatment in the death group were 1 .095 ± 0 .202 ,1 .071 ± 0 .181 ,and 1 .078 ± 0 .198 ,respectively ,those in the survival group were 0 .894 ± 0 .181 ,0 .770 ± 0 .153 ,and 0 .732 ± 0 .137 ,respectively ,which were significantly different (t =4 .66 ,8 .02 and 9 .27 ,respectively ,all P < 0 .01) .The MELD scores at admission and at week 1 and 2 after treatment in the death group were 26 .70 ± 5 .50 ,27 .39 ± 6 .24 ,and 28 .64 ± 6 .44 ,respectively , those in the survival group were 23 .89 ± 4 .41 ,21 .57 ± 4 .68 ,and 18 .87 ± 3 .92 ,respectively ,which were significantly different (t= 2 .53 ,4 .77 and 8 .42 ,respectively ,all P< 0 .01) .Analysis of variance showed that the MELD score and IP-10 expression in the survival group at admission were significantly higher than those at week 1 and week 2 after treatment (F= 13 .464 and 15 .711 ,respectively ,both P< 0 .01) ,while there were no significant differences in the death group (F = 0 .129 and 0 .864 ,respectively ,both P >0 .05) .The AUC of IP-10 at week 2 after treatment was 0 .935 ,that of MELD score was 0 .903 (Z =0 .788 ,P= 0 .045) ,while there was no significant difference of AUC between week 1 and week 2 (0 .935 vs 0 .909 ,Z = 0 .640 ,P> 0 .05) .In addition ,the AUC of IP-10 level at week 1 and MELD score at week 2 after treatment showed no significant difference (0 .909 vs 0 .903 ,Z = 0 .133 , P > 0 .05) .Logistic multivariate regression analysis showed that IP-10 ≥ 0 .902 at week 1 ,MELD ≥ 22 .5 and IP-10 ≥ 0 .846 at week 2 were independent risk factors for death (OR= 11 .29 ,6 .60 ,and 15 .27 ,respectively ;95％ CI =1 .06 - 119 .74 ,1 .27 - 34 .26 ,and 1 .39 - 167 .62 ,respectively ;all P< 0 .05) .Conclusion The dynamic monitor of both IP-10 levels and MELD scores may have greater value in predicting prognosis of patients with HBV-ACLF .%目的 探讨HBV相关慢加急性(亚急性)肝功能衰竭(hepatitis B virus related acute-on-chronic live failure,HBV-ACLF)患者PBMC中干扰素诱导蛋白10(interferon-inducible protein-10,IP-10)的表达和终末期肝病模型(model for end-stage live disease,MELD)评分的动态变化对患者短期预后的判断价值.方法 选取2013年10月至2015年8月湖北文理学院附属医院收治的HBV-ACLF患者80例,随访3个月,死亡33例,存活47例.比较两组患者入院时 、治疗1周 、治疗2周的IP-10表达水平和MELD评分.应用受试者工作特征曲线下面积(area under curve,AUC)评估IP-10及MELD评分对预后的准确性,采用多元logistic回归分析 、Kaplan-Meier生存曲线分析IP10表达和MELD评分对HBV-ACLF患者病死率的影响.结果 入院时 、治疗1周 、治疗2周时,未存活组患者的IP-10表达分别为1.095±0.202、1.071±0.181和1.078±0.198,存活组患者分别为0.894±0.181、0.770±0.153和0.732±0.137,两组比较差异有统计学意义(t值分别为4.66、8.02和9.27,均P<0.01).未存活组患者的MELD分别为26.70±5.50、27.39±6.24和28.64±6.44,存活组患者分别为23.89±4.41、21.57±4.68和18.87±3.92,两组比较差异有统计学意义(t值分别为2.53、4.77和8.42,均P<0.01).存活组患者入院时MELD评分和IP-10表达均明显高于治疗1周和2周时(F=13.464、15.711,均P<0.01);而未存活组3个时间段比较,差异无统计学意义(F=0.129、0.864,均P>0.05).治疗2周时IP-10的AUC为0.935,MELD的AUC为0.903(Z=0.788,P=0.045);但治疗1周与2周时IP-10的AUC差异无统计学意义(0.935比0.909,Z=0.640,P>0.05).且治疗1周时IP10和治疗2周时MELD的AUC差异无统计学意义(0.909比0.903,Z=0.133,P>0.05).1周时IP-10≥0.902、2周时MELD>22.5和2周时IP-10≥0.846是患者死亡的独立危险因素(OR值分别为11.29、6.60和15.27,95％CI分别为1.06～119.74、1.27～34.26、1.39～167.62,均P<0.05).结论IP-10表达与MELD动态监测联合用于HBV-ACLF预后评估有更大的临床应用价值.
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