慢加急性肝衰竭前期患者血清M30和M65水平预测预后价值探讨

摘要

Objective To evaluate serum M30 and M65 levels in patients with acute-on-chronic pre-liver failure (pre-ACLF) and to investigate their value for early diagnosis of acute-on-chronic liver failure (ACLF). Methods Serum M30 and M65 levels in patients with pre-ACLF (n=35),ACLF (n=40),chronic hepatitis B (CHB,n=20) and healthy controls (n=20) were determined by enzyme-linked immunoabsorbent assay. The clinical significance for early diagnosis of ACLF was analyzed. Results Significantly higher serum M30 and M65 levels were found in patients with ACLF and with pre-ACLF compared with CHB or healthy controls (P<0.05);In pre-ACLF patients,serum M30 and M65 levels [(493.80 ±143.85)U/L and (712.47 ±305.67) U/L] were higher in 15 patients who progressed to ACLF than 20 recovered [(351.40±127.78)U/L and(448.15±165.14) U/L,respectively, P<0.05];No significant difference was found in serum M30 and M65 levels between 15 patients with pre-ACLF who switched to ACLF and 40 patients with ACLF(P>0.05);The area under receiver operating characteristic curve (AUC) demonstrated that both serum M30 and M65 had diagnostic value (AUC≥0.80) in identifying early ACLF from pre-ACLF patients(0.877 and 0.867,respectively);When serum M30 levels were ≥453.70 U/L,the sensitivity and specificity for diagnosis of ACLF was 0.867and 0.850,respectively,and when serum M65 levels were≥626.71 U/L,the sensitivity and specificity for diagnosis of ACLF was 0.800 and 0.850,respectively;No significant difference was found in serum M30 and M65 levels between 20 survived patients with ACLF as compared with 20 died (P>0.05). Conclusions In patients with pre-ACLF,serum M30 and M65 levels may serve as important biomarkers for early diagnosis of ACLF.%目的：探讨慢加急性肝衰竭前期（pre-ACLF）患者血清M30和M65水平在早期诊断慢加急性肝衰竭（ACLF）患者的价值。方法采用ELISA法检测35例pre-ACLF患者（痊愈20例、进展15例）、40例 HBV 相关ACLF 患者（生存20例，死亡20例）、20例慢性乙型肝炎患者（CHB）和20例健康对照者血清M30和M65水平，分析其对pre-ACLF及ACLF患者临床转归的预测价值。结果 ACLF组和pre-ACLF组血清M30和M65水平均显著高于健康对照组或CHB患者，ACLF组显著高于pre-ACLF组（P<0.05）；pre-ACLF进展组血清M30和M65[分别为（493.80±143.85）U/L和（712.47±305.67）U/L]，与痊愈组[分别为（351.40±127.78）U/L和（448.15±165.14）U/L]比，差异具有统计学意义（P<0.05）；pre-ACLF进展组与ACLF患者比，血清M30和M65水平[分别为（503.29±184.43） U/L和（746.99±275.19）U/L]，均无显著性差异（P>0.05）；以血清M30和M65水平鉴别诊断Pre-ACLF临床转归的ROC曲线下面积（AUC）分别为0.877和0.867；当M30≥453.70 U/L时，其预测预后的灵敏度和特异度分别为0.867和0.850；当M65≥626.71 U/L时，其早期预测ACLF的灵敏度和特异度分别为0.800和0.850。死亡的ACLF患者血清M30和M65水平虽高于ACLF好转组，但差异无统计学意义。结论 M30和M65是反应肝衰竭及肝衰竭前期患者肝细胞坏死或凋亡较敏感的指标，可用于早期诊断ACLF。