可溶性CD163对慢加急性肝功能衰竭短期预后的预测价值

目的探索可溶性CD163（sCD163）在不同肝脏疾病谱中的水平,以及对慢加急性肝功能衰竭短期预后的预测价值。方法前瞻性纳入慢性乙型肝炎、肝硬化及慢加急性肝功能衰竭患者作为学习队列,检测血清CD163水平;回顾性纳入连续的慢加急性肝功能衰竭患者验证sCD163水平对慢加急性肝功能衰竭的28 d生存期的预测。结果纳入171例患者进入学习队列。慢加急性肝功能衰竭患者sCD163高于慢性乙型肝炎或者肝硬化患者。sCD163水平与血清总胆红素（Rs=0.6199,P〈0.01）、凝血酶原时间国际标准化率（Rs=0.5751,P〈0.01）正相关,与外周血红细胞计数（Rs=-0.2194,P=0.0232）、纤维蛋白原水平（Rs=-0.3898,P〈0.01）负相关。sCD163水平（HR=2.601,P=0.01）与肝性脑病（HR=5.003,P〈0.01）是28 d生存率的独立预测因素,模型具有较好的预测能力（曲线下面积=0.83,P〈0.01）,并在回顾性队列中得到验证。结论血清sCD163水平是预测慢加急性肝功能衰竭短期预后的优良候选指标。

The predictive value of soluble CD163 levels for the short-term survival in patients with acute on chronic liver failure patients

Objective To investigate soluble CD163 levels in HBV related liver diseases and its possible predictive value for short-term period clinical outcome in patients with acute on chronic liver failure. Methods A prospective cohort of patients,including chronic hepatitis B,HBV related liver cirrhosis and acute on chronic liver failure,was performed and soluble CD163 levels of these volunteers were quantitatively measured. A cohort consisted of acute on liver failure patients was retrospectively collected for validation purpose. Results There were 171 patients in the prospective cohort including 40 hepatitis B,49 liver cirrhosis and 82 liver failure cases. Soluble CD163 levels were higher in liver failure cases than in cirrhosis or hepatitis patients. Soluble CD163 levels were positively correlated with total bilirubin（ Rs = 0. 6199,P〈 0. 01）,prothrombin time and INR levels（ Rs = 0. 5751,P〈 0. 01）,while they were negatively correlated with red blood cell counts（ Rs =- 0.2194,P = 0. 0232） and fibrinogen levels（ Rs =- 0. 3898,P〈 0. 01）. Both soluble CD163 levels（ HR = 2. 601,P = 0. 01） and hepatic encelphalopathy（ HR = 5. 003,P〈 0. 01） were independent factors related to 28 days survival. The new model combined with soluble CD163 and hepatic encelphalopathy could effectively prediced 28 days survival（ area under receiver operating characteristic curve = 0. 83,P〈 0. 01）,which was validated in the retrospective cohort. Conclusions Soluble CD163 levels are a potential candidate biomarker to predict short-term survival of patients with acute on chronic liver failure.