外周血白细胞介素32和金属基质蛋白酶-2对HBV相关慢加急性肝衰竭预后的预测价值研究

目的探讨外周血白细胞介素(interleukin,IL)-32和金属蛋白酶(matrix metalloproteinases,MMP)-2表达水平对HBV相关慢加急性肝衰竭(HBV-associated acute-on-chronic liver failure,HBV-ACLF)预后的预测价值。方法选择34例HBV-ACLF和31例慢性乙型肝炎(chronic hepatitis B,CHB)患者作为研究对象,检测外周血IL-32和MMP-2的表达水平,并与ALT、AST、TBIL、ALB及PT等指标进行相关性分析;采用Logisitic回归分析IL-32和MMP-2预测HBV-ACLF预后的价值。结果 HBV-ACLF组IL-32与TBIL、PT呈中等程度正相关(r_s=0.774、0.686),与ALB呈弱负相关(r_s=-0.456);MMP-2与ALB呈弱负相关(r_s=-0.451);IL-32与MMP-2呈弱正相关(r_s=0.580)。CHB组IL-32与TBIL、PT呈弱正相关(r_s=0.439、0.555);MMP-2与AST呈弱正相关(r_s=0.417),与ALB呈弱负相关(r_s=-0.541),与TBIL、PT呈中等程度正相关(r_s=0.647、0.766);IL-32与MMP-2呈弱正相关(r_s=0.590)。HBV-ACLF组、CHB组和对照组外周血IL-32表达水平呈依次升高(P均0.05)。HBV-ACLF组MMP-2表达高于CHB组和对照组(P均0.05),但CHB组与对照组相比,差异无统计学意义。在合并感染率、外周血IL-32和MMP-2表达水平方面,HBV-ACLF组明显高于CHB组。Logisitic回归分析发现IL-32与HBV-ACLF的预后密切相关。结论外周血IL-32和MMP-2的表达水平可反映肝损伤严重程度;IL-32与HBV-ACLF的预后密切相关。     

HBV相关慢加急性肝衰竭患者体内细胞因子表达及动态变化的研究

目的 探讨乙型肝炎相关慢加急性肝衰竭(HBV-related acute-on-chronic liver failure,HBV-ACLF)患者体内细胞因子表达及动态变化的临床意义.方法 选择我院2010年3-10月收治的HBV-ACLF患者43例(HBV-ACLF组),同时选取同期慢性乙型肝炎(chronic he...     

慢加急性乙型肝炎肝衰竭患者血清IL-10和GP73水平检测及其临床意义

目的 探讨HBV相关慢加急性肝衰竭（HBV-ACLF）患者血清IL-10和GP73水平变化及其临床意义。方法 在56例HBV-ACLF患者、32例慢性乙型肝炎（CHB）患者和20例健康人,采用酶联免疫吸附法检测基线血清IL-10和GP73水平。随访HBV-ACLF患者3个月,进行重复检测。结果 基线时HBV-ACLF组血清IL-10水平为（32.4±14.8） pg/ml,显著高于CHB组的（15.2±6.3） pg/ml或健康人的（6.1±1.9） pg/ml （P<0.05）; HBV-ACLF组血清GP73 水平为（283.4±95.4） ng/ml,显著高于CHB组的（129.7±58.1） ng/ml或健康人的（45.5±16.2） ng/ml （P<0.05）;33例生存的HBV-ACLF患者基线血清IL-10 水平为（34.6±15.3） pg/ml,显著高于23例死亡患者的（30.1±14.3） pg/ml（P<0.05）,但生存组与死亡组血清GP73水平差异无统计学意义【（279.7±94.6） ng/ml 对（287.2±96.2） ng/ml,P=0.36】;治疗2周时,HBV-ACLF生存组血清IL-10水平为（30.1±14.0） pg/ml,仍显著高于死亡组的（24.9±11.2） pg/ml（P<0.05）,但不同于基线时,治疗2周时生存与死亡患者血清GP73水平出现了统计学差异【（258.7±85.9） ng/ml对（331.2±107.5） ng/ml,P<0.05】。结论 HBV-ACLF患者血清IL-10 水平高者可能预后相对较好,而动态观察血清GP73水平变化可能对预测HBV-ACLF患者的短期预后也有一定的价值。     

Can Serum ST2 Levels Be Used as a Marker of Fibrosis in Chronic Hepatitis B Infection?

Interleukin 33 (IL-33) is a cytokine belonging to the IL-1 superfamily. Soluble ST2 (sST2) binds to IL-33 and by functioning as trap receptor inhibits signal sending to Th2 via transmembrane ST2. Because Th2-type cytokines play an important role in fibrosis, the aim of this study is to determine whether sST2 can be used as a marker of fibrosis in chronic hepatitis B (CHB) patients or not.The study included 19 healthy controls, 54 patients with CHB, and 14 patients with cirrhosis because of CHB. The aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the 4 factors (FIB-4) scores also calculated, and correlations between liver biopsies, sST2 levels, and these scores were analyzed in CHB and cirrhosis patients.The sST2 levels in patients with CHB were significantly higher than those in the control group subjects (median: 1133 pg/mL vs 762.5 pg/mL, respectively [P = 0.035]). In CHB patients, the METAVIR fibrosis score (stages from 0 to 4) showed a moderate correlation with serum sST2 level (r = 0.396, P = 0.004) and a weak correlation with FIB-4 score (r = 0.359, P = 0.008), but no correlation with APRI score (r = 0.253, P = 0.06). The under the curve value of serum sST2 was 0.68, and its prediction of significant fibrosis (METAVIR score ≥2) in values >674 pg/mL had a sensitivity of 91.7% and specificity of 40% (P = 0.009). According to multiple logistic regression analysis, only METAVIR fibrosis stage was found to be an independent predictor of serum sST2 elevation in CHB patients (P = 0.04).The sST2 level can be used for differentiating significant fibrosis from mild fibrosis in CHB patients. However, the efficacy of this marker should be verified by larger studies in the future.     

Th17/Treg细胞因子在乙型肝炎慢加急性肝衰竭患者中的表达及意义

目的探讨乙型肝炎慢加急性肝衰竭患者(HBV-ACLF)血清中Th17/Treg细胞因子(IL-17/IL-35)的表达及其临床意义。方法收集兰州市第二人民医院2010年12月至2013年12月收治的HBV-ACLF患者共33例(HBVACLF组),选取同期住院的慢性乙型肝炎(CHB)患者42例(CHB组)和20例健康体检者(健康对照组)。采用ELISA法检测3组病例血清中IL-17与IL-35水平,同时检测各项肝功能指标。结果 HBV-ACLF组与CHB组患者IL-17、IL-35水平分别为(137.47±60.81)、(242.39±81.80)、(121.63±57.25)、(212.05±123.98)pg/mL,均高于健康对照组(16.37±8.47)、(33.6±24.63)pg/mL,(t=6.496、6.136、5.857、5.441,P0.01);HBV-ACLF组与CHB组IL-17、IL-35水平差异无统计学意义(t=0.987、1.034,P0.05)。结论 IL-17、IL-35的高水平表达可能与乙型肝炎慢加急性肝功能衰竭的发生有关。     

血清M30抗原水平对HBV相关慢加急性肝衰竭的预后评估价值

目的探索HBV感染后不同疾病阶段的肝细胞凋亡水平及其对HBV相关慢加急性肝衰竭(HBV-ACLF)预后的评估价值。方法前瞻性纳入40例慢性乙型肝炎(CHB)、40例乙型肝炎肝硬化(HBV-LC)以及54例HBV-ACLF患者,同时设立40例健康对照(HC)。针对HBV-ACLF患者随访3个月,根据随访结果分为存活组及死亡组。检测所有研究对象血清角蛋白18凋亡特异性裂解片段M30抗原水平作为反映肝细胞凋亡水平的间接指标。结果 CHB、HBVLC及HBV-ACLF组血清M30抗原水平分别为145.24(IQR86.31,206.39)U/L,213.42(IQR147.30,391.28)U/L及762.67(IQR492.45,1395.24)U/L,均显著高于HC组[60.34(IQR50.58,67.64)U/L](P0.01)。随着疾病严重程度升高,血清M30抗原呈现递增趋势,尤以HBV-ACLF组最高,显著高于CHB(P0.01)及HBV-LC组(P0.01)。M30抗原与ALT、AST、TBil、PT、INR以及HBV DNA呈显著正相关(均P0.01),与Alb呈显著负相关(P0.01)。HBVACLF随访3个月死亡组患者血清M30抗原水平[1175.18(IQR756.57,3224.94)U/L]显著高于存活组患者[491.39(IQR264.23,657.17)U/L](P0.01)。血清M30抗原能够良好地预测HBV-ACLF患者3个月预后情况,曲线下面积为0.86(95%CI0.75~0.96,P0.01)。结论肝细胞凋亡水平与HBV感染后的疾病严重程度密切相关,血清M30抗原可能成为HBV相关慢加急性肝衰竭早期预后的候选指标。     

血清IL-8水平预测HBV相关慢加急性肝衰竭患者短期预后的临床研究

目的探讨血清IL-8水平用于评价HBV相关慢加急性肝衰竭(HBV related acute-on-chronic liver failure,HBVACLF)患者短期预后的临床价值。方法纳入2016年1月—2018年8月我院收住的HBV-ACLF患者110例,根据住院60 d内是否病死分为生存组(n=64)及病死组(n=46)。收集患者入院时临床资料并计算终末期肝病模型(model of endstage liver disease,MELD)评分,检测血清IL-8水平,使用ROC曲线分析血清IL-8水平用于评价患者短期预后的价值。结果病死组患者血清IL-8水平及MELD评分均显著高于生存组,差异有统计学意义(P均<0.05)。预测HBV-ACLF患者60 d病死情况时,IL-8的AUC为0.817,MELD评分的AUC为0.811,IL-8联合MELD评分预测60 d病死情况的AUC为0.841。入院时高IL-8水平(≥349.7 pg/ml)患者60 d总体生存率著低于低IL-8水平(<349.7 pg/ml)患者(36.4%vs.80.0%,Log-rank P<0.001)。结论血清IL-8水平作为评价HBV-ACLF患者短期预后指标具有较好的临床价值。     

Early warning and clinical outcome prediction of acute-onchronic hepatitis B liver failure

Hepatitis B virus(HBV) associated acute-on-chronic liver failure(ACLF) is an increasingly recognized fatal liver disease encompassing a severe acute exacerbation of liver function in patients with chronic hepatitis B(CHB). Despite the introduction of an artificial liver support system and antiviral therapy, the short-term prognosis of HBV-ACLF is still extremely poor unless emergency liver transplantation is performed. In such a situation, stopping or slowing the progression of CHB to ACLF at an early stage is the most effective way of reducing the morbidity and mortality of HBV-ACLF. It is well-known that the occurrence and progression of HBV-ACLF is associated with many factors, and the outcomes of HBV-ACLF patients can be significantly improved if timely and appropriate interventions are provided. In this review, we highlight recent developments in early warning and clinical outcome prediction in patients with HBV-ACLF and provide an outlook for future research in this field.     

HBV相关慢加急性肝衰竭发病诱因分析

目的分析HBV相关慢加急性肝衰竭（HBV-related acute-on-chronic liver failure, HBV-ACLF）诱因及预后影响因素。方法回顾性分析我院2007年3月-2010年2月收治的HBV—ACLF病例资料,对其诱因、临床转归及预后相关因素进行统计学分析。结果509例HBV—ACLF中,HBeAg（＋）287例,HBeAg（-）222例。能够追寻到明确诱因的,以抗病毒治疗相关因素为主,共67例,占13．2％。HBeAg（＋）与HBeAg（-）ACLF相比,抗病毒治疗相关因素诱发HBV—ACLF差异有统计学意义,分别为48例（16．7％）和19例（8．6％）。HBeAg（＋）和HBeAg（-）患者中断抗病毒治疗至发生ACLF的时间差异无统计学意义。509例HBV—ACLF治愈或好转266例（52．3％）。各诱发因素所致ACLF治愈好转率差异无统计学意义。Logistic回归多因素分析发现,HBV—ACLF预后与基础疾病、HBVDNA水平、病情分期及发病后是否采用抗病毒治疗密切相关。不能明确诱因的HBV-ACLF共210例（41．3％）。结论抗病毒药物的广泛应用使HBV-ACLF的诱因分布发生了变化,应重视抗病毒药物应用的规范化。一旦发生ACLF预后差,应及时给予适当的抗病毒治疗,并重视基础疾病的综合治疗。     

Soluble ST2 (sST2) as potential marker for hepatic cystic echinococcosis activity

Objectivesthis study aims to identify the potential marker for hepatic cystic echinococcosis (CE) activity.Methodstotally 97 CE patients and 47 health control (HC) subjects were included. Based on the ultrasound (US) images, CE patients were further categorized as active CE (ACE; 52 cases) and inactive CE (IACE; 45 cases). The sST2 and IL (interleukin)-33 levels were measured by enzyme-linked immunosorbent assay. Univariate, multivariate and subgroup analysis were performed. The relationship between sST2 and CE activity was analyzed by the smooth curve fitting. The receiver operating characteristic (ROC) curve analysis was also performed.Resultsthe serum sST2 level in the CE patients was significantly higher than the HC subjects. Moreover, there was significant difference in the serum sST2 level between the ACE and IACE group. However, no significant difference was observed in the IL-33 level between the ACE and IACE groups. Univariate analysis showed that CE activity was significantly correlated with the sST2 level when the sST2 was greater than 1496.6 pg/mL. Multivariable analysis after adjustment for potential confounding factors, and subgroup analysis showed that sST2 had independent effect on CE activity. ROC curve showed that sST2 could differentially diagnose CE activity at the cut-off value of 1246.550 pg/mL with an AUC of 0.770.Conclusionthe sST2 could be used as a biomarker for hepatic CE activity. High levels of sST2 suggest that the hepatic CE is more likely to be active. Our findings have important guiding significance for the diagnosis of CE activity and the choice of treatment methods.     

Serum NGAL Is Superior to Cystatin C in Predicting the Prognosis of Acute-on-Chronic Liver Failure

Introduction and aim. Acute-on-chronic liver failure (ACLF) is a syndrome with high short-term mortality, and predicting the prognosis is challenging. This study aimed to compare the performance of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (CysC) in predicting the 90-day mortality in patients with hepatitis B virus (HBV)-associated ACLF (HBV-ACLF). Materials and methods. This prospective, observational study enrolled 54 patients with HBV-ACLF. The serum NGAL and CysC levels were determined. A multivariate logistic regression analysis was used to analyze the independent risk factors of mortality. Results. Serum NGAL, but not CysC, was found to significantly correlate with the total bilirubin, international normalized ratio, and model for end-stage liver disease (MELD). Serum NGAL [odds ratio (OR), 1.008; 95% confidence interval (CI), 1.004-1.012; P < 0.01], but not CysC, was an independent risk factor for developing hepatorenal syndrome. Moreover, NGAL (OR, 1.005; 95% CI, 1.001-1.010; P < 0.01) along with the MELD score was independently associated with the overall survival in patients with HBV-ACLF. Patients with HBV-ACLF were stratified into two groups according to the serum NGAL level at baseline (low risk: <217.11 ng/mL and high risk: ≥ 217.11 ng/mL). The 90-day mortality rate was 22.73% (5/22) in the low-risk group and 71.88% (23/32) in the high-risk group. Moreover, NGAL, but not CysC, significantly improved the MELD score in predicting the prognosis of HBV-ACLF. Conclusion. The serum NGAL might be superior to CysC in predicting the prognosis of HBV-ACLF with the normal creatinine level.     

血浆置换联合血液滤过对乙型肝炎相关慢加急性肝衰竭患者血清IL-17和IL-6的影响

目的探讨血浆置换联合血液滤过对乙型肝炎相关肝衰竭血清白细胞介素(IL)-17、IL-6的影响。方法 30例乙型肝炎慢加急性肝衰竭患者在内科治疗的基础上采用血浆置换联合血液滤过单次治疗。用ELISA检测各组血清IL-17、IL-6浓度,同时记录血清ALT、TBil等值并进行统计分析。结果肝衰竭组患者血清IL-17、IL-6水平分别为(123.5±23.0)pg/ml、(110.0±18.5)pg/ml,高于慢性乙型肝炎患者(48.5±6.3)pg/ml、(27.8±5.9)pg/ml和正常对照组(34.7±3.3)pg/ml、(12.1±5.1)pg/ml,P均<0.001;治疗后血清IL-17、IL-6水平分别为(84.7±21.4)pg/ml、(75.8±16.6)pg/ml,较治疗前下降(t=35.1,P<0.001;t=33.4,P<0.001);与好转组相比,人工肝对恶化组血清IL-17、IL-6清除效率降低(t=3.8,P<0.05;t=3.9,P<0.05);人工肝对血清IL-17、IL-6清除效率均与MELD评分呈负相关(r=-0.53、P=0.003;r=-0.43,P=0.015)。结论血浆置换联合血液滤过能有效降低肝衰竭患者血清IL-17、IL-6水平,其对IL-17、IL-6的清除效率可能与患者预后有关。     

Elevated serum prostaglandin E2 predicts the risk of infection in hepatitis B virus-related acute-on-chronic liver failure patients

Objective: To evaluate the serum Prostaglandin E2(PGE2) level in Acute-on-chronic liver failure(ACLF) and determine its predicative value for infection.Methods: From April 2014 to April 2015, ninety-one patients with hepatitis B virus and ACLF but without infection were enrolled into this prospective study that was carried out at our Hospital. Twenty patients with stable chronic hepatitis B were enrolled from the outpatient department and twenty healthy control subjects without any disease were enrolled from hospital staff. Serum PGE2 levels were determined using ELISA at enrollment. Clinical and laboratory parameters were collected. Receiver operating characteristic(ROC) curves were used to determine optimal cut-off values to predict infection.Results: Significantly higher PGE2 levels were found in patients with ACLF in comparison with healthy controls and patients with stable CHB(P 0.000 1). In ACLF patients, PGE2 levels were significantly higher in patients that eventually developed infection than those without this complication(P 0.000 1). ROC analysis showed that serum PGE2(area under the ROC curve, 0.83) could predict infection in patients with ACLF with sensitivity of 78.4% and specificity of 81.5% using a threshold of 141 pg/m L.Conclusions: Serum PGE2 is associated with the susceptibility to secondary infections for patients with ACLF. Increased PGE2 serum levels may serve as a potential biomarker for developing infections in ACLF patients.     

Chronic liver failure-consortium acute-on-chronic liver failure and acute decompensation scores predict mortality in Brazilian cirrhotic patients

AIM To validate prognostic scores for acute decompensation of cirrhosis and acute-on-chronic liver failure in Brazilian patients.METHODS This is a prospective cohort study designed to assess the prognostic performance of the chronic liver failure-consortium(CLIF-C) acute decompensation score(CLIF-C AD) and CLIF-C acute-on-chronic liver failure score(CLIF-C ACLF),regarding 28-d and 90-d mortality,as well as to compare them to other prognostic models,such as Model for End-Stage Liver Disease(MELD),MELD Sodium(MELD-Na),ChildPugh(CP) score,and the CLIF-C Organ Failure score(CLIF-C OF). All participants were adults with acute decompensation of cirrhosis admitted to the Emergency Department of a tertiary hospital in southern Brazil. Prognostic performances were evaluated by means of the receiver operating characteristic(ROC) curves,area under the curves(AUC) and 95%CI.RESULTS One hundred and thirteen cirrhotic patients were included. At admission,18 patients had acute-onchronic liver failure(ACLF) and 95 individuals had acute decompensation(AD) without ACLF,of which 24 eventually developed ACLF during the course of hospitalization(AD evolving to ACLF group). The AD group had significantly lower 28-d(9.0%) and 90-d(18.3%) mortality as compared to the AD evolving to ACLF group and to the ACLF group(both P 0.001). On the other hand,28-d and 90-d mortalities were not significantly different between AD evolving to ACLF group and ACLF group(P = 0.542 and P = 0.708,respectively). Among patients with ACLF,at 28 d from the diagnosis,CLIF-C ACLF was the only score able to predict mortality significantly better than the reference line,with an AUC(95%CI) of 0.71(95%CI: 0.54-0.88,P = 0.021). Among patients with AD,all prognostic scores performed significantly better than the reference line regarding 28-d mortality,presenting with similar AUCs: CLIF-C AD score 0.75(95%CI: 0.63-0.88),CP score 0.72(95%CI: 0.59-0.85),MELD score 0.75(95%CI: 0.61-0.90),MELD-Na score 0.76(95%CI: 0.61-0.90),and CLIF-C OF score 0.74(95%CI: 0.60-0.88). The same occurred concerning AUCs for 90-d mortality: CLIF-C AD score 0.70(95%CI: 0.57-0.82),CP score 0.73(95%CI: 0.62-0.84),MELD score 0.71(95%CI: 0.59-0.83),MELD-Na score 0.73(95%CI: 0.62-0.84),and CLIF-C OF score 0.65(95%CI: 0.52-0.78).CONCLUSION This study demonstrated that CLIF-C ACLF is the best available score for the prediction of 28-d mortality among patients with ACLF. CLIF-C AD score is also useful for the prediction of mortality among cirrhotic patients with AD not fulfilling diagnostic criteria for ACLF,but it was not superior to other well-established prognostic scores.     

HBV相关慢加急性肝衰竭患者血清角蛋白18水平及其与患者预后的关系探讨*

目的 探讨乙型肝炎病毒相关性慢加急性肝衰竭（HBV-ACLF）患者血清角蛋白18（K-18）水平变化及其对患者预后的预测价值。方法 2015年1月~2017年1月我院收治的HBV-ACLF患者100例,另选择性别和年龄相匹配的慢性乙型肝炎（CHB）患者30例和健康人30例。采用酶联免疫吸附试验法检测血清K18（M30和M65）水平。随访3 m。应用受试者工作特征曲线（ROC）分析M30/M65比值和终末期肝病模型（MELD）预测患者预后的效能。结果 ACLF患者血清M30、M65水平和M30/M65比值分别为（1.0±0.1） lg U/L、（3.4±0.3） lg U/L和（0.3±0.1）,与CHB患者【分别为（2.1±0.1） lg U/L、（3.3±0.2） lg U/L和（0.6±0.0）】或者健康人【分别为（2.1±0.1） lg U/L、（2.1±0.1） lg U/L和（1.0±0.2）】比,有显著性统计学差异（P<0.05）;68例生存患者MELD评分为（18.2±.0）,显著低于32例死亡患者的【（26.1±3.3）,P<0.05】,血清M65水平为（2.9±0.2） lg U/L,显著低于死亡患者的【（4.1±0.5） lg U/L,P<0.05】,M30/M65比值为（0.4±0.1）,显著高于死亡患者的【（0.2±0.1）,P<0.05】;MELD评分预测ACLF患者死亡的截断点为23.21,其AUC为0.650,预测的灵敏度、特异度和正确性分别为85.5%、65.0%和72.0%,而M30/M65比值预测ACLF患者死亡的截断点为0.30,其AUC为0.875,预测的灵敏度、特异度和正确性分别为94.5%、85.0%和85.0%,显著优于MELD评分（P<0.05）。结论 K18（M30和M65）与肝脏疾病的严重程度有关。早期检测血清M30和M65水平可能有助于对HBV-ACLF患者预后的判断。     

Usefulness of serum thyroid-stimulation hormone (TSH) as a prognostic indicator for acute-on-chronic liver failure

Background and rationale for the study. To investigate thyroid function in patients with acute-on-chronic liver failure (ACLF) caused by hepatitis B virus infection and to determine whether thyroid hormone levels can be used as prognostic markers for assessing severity and prognosis of ACLF patients. We enrolled 75 patients with ACLF and70 patients with chronic hepatitis B (CHB).Continual serum samples were collected during hospitalization from the ACLF patients. The serum thyroid hormone levels (triiodothyronine [T3], thyroxine [T4], free (F)-T3, FT4, and thyroid stimulation hormone [TSH]) were measured by chemiluminescence. The Model for End-stage Liver Disease (MELD) score was used to assess severity.Results. ACLF patients showed significantly (p < 0.001) lower values of serum T3, T4, FT3/FT4 and TSH than CHB patients. The T3, T4, and TSH levels in ACLF patients were negatively correlated with the MELD score (T3: r = -0.495, p < 0.001; T4: r = -0.281, p < 0.001; TSH: r = -0.498, p < 0.001), suggesting that serum thyroid hormone levels reflect disease severity. At 1 year, 31 patients died. The T3 (p = 0.016), T4 (p = 0.008), and TSH (p = 0.003) levels in non-survivors were significantly lower than in survivors. The serum TSH level was a significant factor for predicting mortality in ACLF patients (optimal cutoff value = 0.38 IU/mL). The cumulative survival rate was decreased significantly when the serum TSH level was < 0.38 IU/mL (39.2%, p < 0.001).Conclusion. Serum TSH level may be a useful indicator for assessing severity and prognosis in ACLF patients.     

HBV相关慢加急性肝衰竭患者Th17、Treg变化及其与临床相关性

目的研究Th17、Treg及Th17/Treg在乙型肝炎相关慢加急性肝衰竭(ACHBLF)患者外周血的变化,及其与病情进展及预后的相关性。方法选取33例ACHBLF患者,30例慢性乙型肝炎患者及11名健康对照。用流式细胞技术检测血清中Th17、Treg频数,分析ACHBLF患者Th17、Treg频数的变化及其与TBil、ALT、PT等指标的相关性。结果ACBLF患者的Th17(1.96±0.99)%比CHB患者(0.59±0.40)%及健康对照者(0.26±0.20)%高(P0.05);ACHBLF的Th17/Treg(0.46±0.32)比CHB患者(0.12±0.11)及健康对照者(0.07±0.06)的高(P0.05);ACHBLF患者中,死亡者的Th17比存活者高;Th17细胞频数及Th17/Treg与PT、ALT及AST呈正相关(P0.05),与总胆红素无显著相关性,Th17/Treg与AFP呈正相关(P0.05)。结论 ACHBLF患者存在不同程度的免疫功能紊乱,Th17及Th17/Treg与病情进展相关,且对患者预后有重要价值,Th17越高预后越差。     

Serum soluble suppression of tumorigenicity 2 as a novel inflammatory marker predicts the severity of acute pancreatitis

BACKGROUNDAcute pancreatitis (AP) is an inflammatory disease in which the regulatory pathway is complex and not well understood. Soluble suppression of tumorigenicity 2 (sST2) protein receptor functions as a decoy receptor for interleukin (IL)-33 to prevent IL-33/suppression of tumorigenicity 2L (ST2L)-pathway-mediated T helper (Th)2 immune responses.AIMTo investigate the role of sST2 in AP.METHODSWe assessed the association between sST2 and severity of AP in 123 patients enrolled in this study. The serum levels of sST2, C-reactive protein (CRP) and Th1- and Th2-related cytokines, including interferon (IFN)-γ, tumor necrosis factor (TNF)-α, IL-2, IL-4, IL-5 and IL-13, were measured by highly sensitive ELISA, and the severity of AP in patients was evaluated by the 2012 Atlanta Classification Criteria. RESULTSSerum sST2 levels were significantly increased in AP patients, and further, these levels were significantly elevated in severe AP (SAP) patients compared to moderately severe AP (MSAP) and mild AP (MAP) patients. Logistic regression showed sST2 was a predictor of SAP [odds ratio (OR): 1.003 (1.001–1.006), P = 0.000]. sST2 cutoff point was 1190 pg/mL, and sST2 above this cutoff was associated with SAP. sST2 was also a predictor of any organ failure and mortality during AP [OR: 1.006 (1.003–1.009), P = 0.000, OR: 1.002 (1.001–1.004), P = 0.012, respectively]. Additionally, the Th1-related cytokines IFN-γ and TNF-α in the SAP group were higher and the Th2-related cytokine IL-4 in the SAP group was significantly lower than those in MSAP and MAP groups. CONCLUSIONsST2 may be used as a novel inflammatory marker in predicting AP severity and may regulate the function and differentiation of IL-33/ST2-mediated Th1 and Th2 Lymphocytes in AP homeostasis.     

血清胱抑素C对慢加急性肝衰竭患者肾损伤的早期诊断意义

目的研究血清胱抑素C(CysC)水平对慢加急性肝衰竭(ACLF)患者急性肾损伤(AKI)的早期诊断意义。方法选取2011年8月-2012年10月于本院住院的慢性乙型肝炎相关慢加急性肝衰竭(ACLF)、慢性乙型肝炎(CHB)的患者各60例,同期60例健康者作为对照。肝衰竭患者随访至出院,动态收集患者血清。采用胶乳增强免疫比浊法测定血清CysC水平。通过绘制CysC、肌酐和血钠浓度诊断AKI的受试者工作特征曲线(ROC),获得其曲线下面积(AUC)及最佳临界值。正态分布的计量资料,多组间比较采用单因素方差分析(One-way ANOVA),2组间比较采用双侧t检验;否则,组间比较采用Mann-Whitney U检验。计数资料采用χ2检验。相关分析采用Pearson相关检验。AUC及最佳临界值的计算采用Medcal 12.7.1.0进行分析。结果肝衰竭患者血清CysC水平为(1050±444)ng/ml,显著高于健康对照组(638±275)ng/ml(P=0.016)和CHB组患者(661±225)ng/ml(P=0.028)。ACLF患者血清CysC水平与肌酐水平相关性不显著(r=0.311,P0.05),但与MELD评分呈显著正相关(r=0.529,P0.01)。住院期间,共有8名肝衰竭患者(13.3%)发展为急性肾损伤,多元Logistic回归分析结果显示,血清CysC水平是ACLF患者发生肾损伤的独立影响因素(OR=1.008,P=0.021)。AUC分析显示早期诊断ACLF患者急性肾损伤的血清CysC水平建议值为1210 ng/ml。结论血清CysC检测有助于ACLF伴肌酐水平正常患者住院期间发生急性肾损伤的早期预测。