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HBV相关慢加急性肝衰竭患者血清HMGB1、sCD163、PGE2的表达水平及其对预后的预测价值

韩晨璐 梁海军 杨道坤 常海燕 魏帅 王新伟 高海丽

引用本文:
Citation:

HBV相关慢加急性肝衰竭患者血清HMGB1、sCD163、PGE2的表达水平及其对预后的预测价值

DOI: 10.12449/JCH240610
基金项目: 

河南省医学科技攻关计划项目 (LHGJ20210532)

伦理学声明: 本研究方案于2022年6月2日经由新乡医学院第一附属医院伦理委员会审批,批号:EC-022-194,所有患者均签署知情同意书。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:韩晨璐、梁海军负责设计研究思路、收集标本与数据、实验操作、撰写论文;常海燕、魏帅负责统计学分析、绘制图表;王新伟、高海丽参与收集标本、修改论文;杨道坤负责拟定写作思路、指导撰写文章并最后定稿。韩晨璐与梁海军对本文贡献等同,同为第一作者。
详细信息
    通信作者:

    杨道坤, dk13949620669@163.com (ORCID: 0000-0003-4606-7457)

Expression levels of serum high-mobility group box 1, soluble CD163, and prostaglandin E2 in patients with hepatitis B virus-related chronic-on-acute liver failure and their value in predicting prognosis

Research funding: 

Medical Science and Technology Research Project of Henan Province (LHGJ20210532)

More Information
  • 摘要:   目的  观察HBV相关慢加急性肝衰竭(HBV-ACLF)患者血清高迁移率族蛋白B1(HMGB1)、可溶性CD163(sCD163)、前列腺素E2(PGE2)的表达水平,并评估三者单独及联合检测对预后的预测价值。  方法  收集2022年7月1日—2023年9月30日在新乡医学院第一附属医院感染内科住院的HBV-ACLF患者76例,根据28天预后情况,将其分为生存组(n=48)和死亡组(n=28)。收集患者一般资料,计算MELD评分,并采用ELISA法检测血清HMGB1、sCD163和PGE2水平。正态分布的计量资料两组间比较采用成组t检验,非正态分布的计量资料两组间比较采用Mann-Whitney U检验;计数资料两组间比较采用χ2检验。采用Spearman秩相关性分析HMGB1、sCD163和PGE2与MELD评分的相关性;采用受试者工作特征曲线(ROC曲线)分析HMGB1、sCD163和PGE2单独及联合检测对HBV-ACLF患者预后的预测价值。  结果  生存组和死亡组间TBil、WBC、中性粒细胞百分数、降钙素原、血清淀粉样蛋白A、IL-6、血清钠(Na+)、血清肌酐(SCr)差异均有统计学意义(P值均<0.05)。死亡组血清HMGB1(Z=-2.997,P=0.003)、sCD163(Z=-2.972,P=0.003)和MELD评分(t=-6.997,P<0.001)显著高于生存组,差异均有统计学意义;死亡组血清PGE2水平显著低于生存组,差异有统计学意义(Z=-4.909,P<0.001)。Spearman秩相关性分析发现,HMGB1、sCD163与MELD评分呈正相关(r值分别为0.431、0.319,P值均<0.05),PGE2与MELD评分呈负相关(r=-0.412,P<0.001)。ROC曲线分析发现,HMGB1、sCD163和PGE2单独预测的曲线下面积(AUC)分别为0.717、0.716、0.856,三者联合预测价值最高,AUC为0.930,敏感度为0.778,特异度为0.920。  结论  血清HMGB1、sCD163、PGE2单独及联合检测在预测HBV-ACLF患者预后方面均具有良好参考价值,三者联合预测价值最高,值得进一步观察和研究。

     

  • 图  1  HMGB1与MELD评分的相关性

    Figure  1.  Correlation between HMGB1 and MELD score

    图  2  sCD163与MELD评分的相关性

    Figure  2.  Correlation between sCD163 and MELD score

    图  3  PGE2与MELD评分的相关性

    Figure  3.  Correlation between PGE2 and MELD score

    图  4  HMGB1、sCD163、PGE2单独及联合检测预测HBV-ACLF患者预后的ROC曲线

    Figure  4.  ROC curves of HMGB1, sCD163 and PGE2 alone and in combination to predict prognosis of HBV-ACLF patients

    表  1  两组患者一般资料比较

    Table  1.   Comparison of general data between the two groups

    指标 生存组(n=48) 死亡组(n=28) 统计值 P
    男/女(例) 34/14 21/7 χ2=0.154 0.695
    年龄(岁) 51.213±13.074 52.643±14.794 t=-0.087 0.931
    Alb(g/L) 31.000(28.575~33.775) 30.750(28.725~33.150) Z=-0.525 0.600
    TBil(µmol/L) 355.203±183.567 475.193±229.273 t=-2.370 0.022
    ALT(U/L) 105.000(38.500~269.750) 91.000(38.750~271.750) Z=-0.044 0.965
    AST(U/L) 134.500(68.000~191.750) 220.000(82.250~401.500) Z=-1.083 0.279
    LDH(U/L) 245.000(218.000~349.250) 368.000(213.750~591.250) Z=-1.421 0.155
    PT(s) 19.400(15.425~22.400) 23.400(16.650~43.158) Z=-1.662 0.096
    PTA(%) 47.360(38.758~61.998) 36.750(21.503~56.285) Z=-1.815 0.075
    INR 1.660(1.337~1.952) 2.145(1.355~3.845) Z=-1.783 0.075
    WBC(×109/L) 6.690(4.965~9.250) 11.370(8.340~15.557) Z=-2.821 0.005
    PLT(×109/L) 110.500(58.250~202.000) 137.500(65.000~196.500) Z=-0.087 0.930
    中性粒细胞百分数(%) 71.250(61.175~81.050) 84.050(79.150~91.225) Z=-3.707 <0.001
    SCr(µmol/L) 43.750(36.425~57.975) 61.900(56.975~97.925) Z=-3.161 0.002
    Na+(mmol/L) 133.625±3.833 128.857±4.928 t=3.599 0.001
    CRP(mg/L) 10.945(5.047~36.680) 32.085(19.615~43.933) Z=-1.689 0.091
    PCT(ng/ml) 0.416(0.183~1.100) 1.250(0.388~1.950) Z=-2.305 0.021
    IL-6(pg/ml) 15.315(6.522~29.265) 34.250(21.047~84.992) Z=-2.960 0.003
    SAA(mg/L) 3.100(1.575~5.175) 9.350(4.575~31.125) Z=-2.877 0.004
    下载: 导出CSV

    表  2  两组患者血清HMGB1、sCD163、PGE2水平和MELD评分比较

    Table  2.   Comparison of serum HMGB1, sCD163, PGE2 levels and MELD scores between the two groups

    指标 生存组(n=48) 死亡组(n=28) 统计值 P
    HMGB1(pg/mL) 756.492(566.918~1 070.678) 1 011.152(795.188~1 465.057) Z=-2.997 0.003
    sCD163(pg/mL) 508.675(361.567~825.933) 728.298(607.953~1 010.074) Z=-2.972 0.003
    PGE2(pg/mL) 441.120(345.941~632.430) 262.286(158.389~334.938) Z=-4.909 <0.001
    MELD评分(分) 13.705±6.243 26.454±8.928 t=-6.997 <0.001
    下载: 导出CSV

    表  3  HMGB1、sCD163、PGE2单独及联合检测对HBV-ACLF患者预后的预测价值

    Table  3.   Prognostic value of HMGB1, sCD163 and PGE2 alone and in combination in HBV-ACLF patients

    指标 最佳截断值 约登指数 敏感度 特异度 AUC 95%CI P
    HMGB1(pg/mL) 788.344 0.400 0.600 0.800 0.717 0.593~0.841 0.003
    sCD163(pg/mL) 544.297 0.440 0.600 0.840 0.716 0.596~0.835 0.003
    PGE2(pg/mL) 342.819 0.618 0.778 0.840 0.856 0.764~0.948 <0.001
    三者联合 0.698 0.778 0.920 0.930 0.875~0.985 <0.001
    下载: 导出CSV
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  • 收稿日期:  2023-10-12
  • 录用日期:  2023-12-25
  • 出版日期:  2024-06-25
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