血清甲胎蛋白在人工肝治疗乙型肝炎相关慢加急性肝衰竭预后评估中的价值

目的探讨甲胎蛋白(AFP)水平在人工肝治疗乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者生存的价值。方法回顾性收集我科人工肝血浆置换治疗HBV-ACLF患者人工肝前的临床检测指标,对比血清AFP水平在人工肝后30、90、180 d生存组与死亡组差异;绘制受试者工作特征曲线(ROC曲线),计算AFP对人工肝术后30、90、180 d生存预测的敏感度、特异度;以中位数将AFP分为高AFP组及低AFP组,分析APF与术后30、90、180 d生存预测价值。结果本研究共计纳入93例患者,30、90、180 d生存组的的AFP分别为(231.0±286.2)ng/ml、(237.69±297)ng/ml、(229.44±286.46)ng/ml,死亡组AFP分别为(76.4±104.7)ng/ml、(103.13±116.99)ng/ml、(136.34±2.9.29)ng/ml,死亡组AFP均显著低于对应生存组(P<0.05);ROC曲线分析提示人工肝术后30、90、180 d的ROC曲线下面积(AUC)和95%可信区间分别为0.739(0.611~0.867),0.675(0.550~0.801),0.653(0.524~0.781)。血清AFP中位数为110 ng/ml,生存分析发现高AFP组人工肝术后30 d(P=0.01)、90 d(P=0.04)及180 d(P=0.03)生存时间均显著高于低AFP组患者。结论血清AFP可作为HBV-ACLF患者人工肝后生存情况的预测因子,临床价值有待进一步扩大样本量验证。

Value of serum alpha-fetoprotein for the prognostic evaluation of hepatitis B virus-related acute-on-chronic liver failure treated with artificial liver

Objective To investigate the value of alpha-fetoprotein(AFP)level on survived hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)patients treated with artificial liver.Methods Clinical indicators of HBV-ACLF patients who were previously treated with plasma exchange-based artificial liver at our department were retrospectively collected.The difference of serum AFP level between the survival and the death group was compared at 30,90 and 180 days after artificial liver treatment.The ROC curves of the subjects were plotted,and the sensitivity and specificity of AFP for the survival prediction of the patients at 30,90 and 180 days after artificial liver surgery were calculated.AFP was divided into a high AFP group and a low AFP group using median value.AFP and postoperative survival predictive value at 30,90,and 180 days were analyzed.Results A total of 93 cases were included in this study.The AFP of the survival group at 30,90,and 180 days was(231.0±286.2)ng/ml,(237.69±297)ng/ml,(229.44±286.46)ng/ml,and the death group was(76.4±104.7)ng/ml,(103.13±116.99)ng/ml,(136.34±2.9.29)ng/ml,respectively.AFP of the death group was significantly lower than the corresponding survival group(P<0.05).Receiver operating characteristic(ROC)curve analyses indicated that the area under the curve(AUC)and its 95%confidence interval at 30,90,and 180 days after artificial liver surgery were 0.739(0.611~0.867),0.675(0.550~0.80),0.653(0.524~0.781),respectively.The median serum AFP value was 110 ng/ml,and the survival analysis showed that the survival time of the high AFP group was significantly higher than the low AFP group at 30 d(P=0.01),90 d(P=0.04)and 180 d(P=0.03)after artificial liver surgery.Conclusion Serum AFP can be used as a predictor of survival for HBV-ACLF patients after artificial liver therapy and its clinical value needs to be further verified by the larger sample size.