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IL-32联合终末期肝病模型对HBV相关慢加急性肝衰竭患者预后的预测价值

顾静 王艳 孙蔚 赵卫峰 甘建和

顾静, 王艳, 孙蔚, 等. IL-32联合终末期肝病模型对HBV相关慢加急性肝衰竭患者预后的预测价值[J]. 临床肝胆病杂志, 2021, 37(2): 304-308. DOI: 10.3969/j.issn.1001-5256.2021.02.012
引用本文: 顾静, 王艳, 孙蔚, 等. IL-32联合终末期肝病模型对HBV相关慢加急性肝衰竭患者预后的预测价值[J]. 临床肝胆病杂志, 2021, 37(2): 304-308. DOI: 10.3969/j.issn.1001-5256.2021.02.012
GU J, WANG Y, SUN W, et al. Value of interleukin-32 combined with Model for End-Stage Liver Disease in predicting the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure[J]. J Clin Hepatol, 2021, 37(2): 304-308. DOI: 10.3969/j.issn.1001-5256.2021.02.012
Citation: GU J, WANG Y, SUN W, et al. Value of interleukin-32 combined with Model for End-Stage Liver Disease in predicting the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure[J]. J Clin Hepatol, 2021, 37(2): 304-308. DOI: 10.3969/j.issn.1001-5256.2021.02.012

IL-32联合终末期肝病模型对HBV相关慢加急性肝衰竭患者预后的预测价值

DOI: 10.3969/j.issn.1001-5256.2021.02.012
基金项目: 

国家科技部“十三五”重大专项 2017ZX10203201002-002

详细信息
    作者简介:

    顾静(1987—),女,主治医师,主要从事病毒性肝炎、肝衰竭及疑难肝病的诊治研究

    通讯作者:

    甘建和,ganjianhe@aliyun.com

  • 利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突,特此声明。
  • 作者贡献申明:顾静负责课题设计,资料分析,撰写论文;王艳、孙蔚参与收集数据,修改论文;赵卫峰、甘建和负责拟定写作思路,指导撰写文章并最后定稿。
  • 中图分类号: R512.62;R575.3

Value of interleukin-32 combined with Model for End-Stage Liver Disease in predicting the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure

  • 摘要:   目的  探讨IL-32联合终末期肝病模型(MELD)对HBV相关慢加急性肝衰竭(HBV-ACLF)患者预后的预测价值。  方法  选取2015年1月-2018年12月在苏州大学附属第一医院住院的92例HBV-ACLF患者,根据确诊后3个月随访情况分为存活组(n=40)和死亡组(n=52)。采用酶联免疫吸附试验(ELISA)测定患者的血清IL-32水平。收集患者的临床资料,包括年龄、性别、合并基础疾病、主要并发症、WBC、PLT、红细胞比积(HCT)、TBil、ALT、AST、Alb、SCr、PT、INR、HBV DNA等。符合正态分布的计量资料2组间比较采用t检验,不符合正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ2检验;IL-32与其他变量进行Pearson相关性分析;采用二元logistic回归分析影响HBV-ACLF患者预后的独立危险因素;利用ROC曲线下面积(AUC)评价IL-32联合MELD评分对HBV-ACLF预后的预测价值,AUC的比较采用正态性Z检验。  结果  2组间HCT、PLT、TBil、SCr、PT、INR、HBV DNA、IL-32、MELD评分比较差异均有统计学意义(P值均<0.05);IL-32与TBil(r=0.952, P<0.001)、MELD评分(r=0.850, P<0.001)均呈显著正相关; IL-32(OR=1.137, 95%CI: 1.040~1.243, P=0.005)和MELD评分(OR=1.055,95%CI:1.001~1.109,P=0.025)是HBV-ACLF患者死亡的独立危险因素; IL-32联合MELD评分对HBV-ACLF患者预后的预测价值最高(AUC=0.992, 95%CI:0.981~1.000),优于IL-32(AUC=0.984)和MELD评分(AUC=0.877),差异均具有统计学意义(Z值分别为2.265、3.182, P值均<0.05)。  结论  IL-32、MELD评分均能预测HBV-ACLF患者预后,两者联合则预测价值更高。
  • 图  1  IL-32与TBil相关性分析

    图  2  IL-32与MELD评分相关性分析

    图  3  IL-32、MELD评分、IL-32联合MELD评分的ROC曲线

    表  1  两组患者一般资料比较

    指标 死亡组(n=52) 存活组(n=40) 统计值 P
    男性[例(%)] 32(61.54) 28(70.00) χ2=0.714 0.398
    年龄(岁) 51.76±10.23 52.55±11.69 t=0.325 0.746
    WBC(×109) 6.76±2.08 7.06±2.33 t=0.610 0.543
    HCT(%) 0.36±0.05 0.39±0.05 t=2.391 0.019
    PLT(×109) 70.67±13.69 92.70±16.69 t=6.550 <0.001
    TBil(μmol/L) 354.30±38.55 272.75±52.55 t=-8.039 <0.001
    ALT(U/L) 679.51±164.75 576.28±139.22 t=-3.057 0.503
    AST(U/L) 667.26±157.49 551.04±141.88 t=-3.480 0.071
    Alb(g/L) 32.76±2.74 33.34±2.78 t=0.952 0.344
    SCr(μmol/L) 78.00(70.50~89.33) 73.65(65.48~78.58) U=611.000 0.034
    PT(s) 32.30(29.73~33.25) 26.25(25.55~27.48) U=98.000 <0.001
    INR 2.60(2.20~2.80) 1.70(1.60~1.90) U=106.000 <0.001
    HBV DNA(×107IU/ml) 2.79±0.69 2.28±0.97 t=-2.736 0.008
    IL-32(pg/ml) 555.80±42.18 408.99±55.56 t=-13.517 <0.001
    MELD评分(分) 26.87±3.01 21.54±3.35 t=-7.596 <0.001
    有肝硬化基础[例(%)] 31(59.62) 19(47.50) χ2=1.338 0.247
    合并基础疾病[例(%)]
      糖尿病 21(40.38) 18(45.00) χ2=0.197 0.657
      心血管疾病 20(38.46) 18(45.00) χ2=0.399 0.528
      慢性肺部疾病 19(36.54) 17(42.50) χ2=0.337 0.561
      慢性肾病 16(30.77) 13(32.50) χ2=0.031 0.859
    主要并发症[例(%)]
      消化道出血 28(53.85) 16(40.00) χ2=1.737 0.188
      腹水 41(78.85) 30(75.00) χ2=0.190 0.663
      肝性脑病 37(71.15) 21(52.50) χ2=3.377 0.066
      肝肾综合征 23(44.23) 15(37.50) χ2=0.422 0.516
    下载: 导出CSV

    表  2  HBV-ACLF患者预后相关因素分析

    指标 单因素分析 多因素分析
    P OR 95%CI P OR 95%CI
    年龄 0.742 0.993 0.954~1.034
    性别 0.853 1.087 0.451~2.618
    WBC 0.538 0.939 0.770~1.147
    HCT 0.023 0.647 0.266~1.575 0.363 0.668 0.280~1.595
    PLT <0.001 0.909 0.872~0.948 0.987 1.013 0.213~4.826
    TBil <0.001 1.036 1.021~1.050 0.831 1.397 0.065~29.828
    ALT 0.515 1.004 1.001~1.008
    AST 0.062 1.005 1.002~1.008
    Alb 0.340 0.925 0.788~1.086
    SCr 0.282 1.014 0.988~1.041
    PT <0.001 2.640 1.745~3.996 0.092 5.852 0.750~45.685
    INR <0.001 683.865 39.105~11 959.338 0.430 647.954 39.695~14 093.261
    HBV DNA 0.011 2.102 1.182~3.736 0.430 1.582 0.506~4.949
    IL-32 <0.001 1.062 1.030~1.094 0.005 1.137 1.040~1.243
    MELD评分 <0.001 1.592 1.317~1.925 0.025 1.055 1.001~1.109
    下载: 导出CSV
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  • 收稿日期:  2020-08-07
  • 修回日期:  2020-09-03
  • 刊出日期:  2021-02-20
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