血清PTX3和sTWEAK预测失代偿期乙型肝炎肝硬化患者死亡临床价值分析

目的 检测失代偿期乙型肝炎肝硬化患者血清正五聚蛋白3(PTX3)和人可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)水平,并分析其预测失代偿期乙型肝炎肝硬化患者死亡的临床价值。方法 2016年1月～2019年6月我院肝病科收治的失代偿期乙型肝炎肝硬化患者108例,随访6个月。采用化学发光免疫分析法测定血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和C反应蛋白(CRP)水平,采用ELISA法测定血清PTX3和sTWEAK水平。应用Logistic回归分析失代偿期乙型肝炎肝硬化患者死亡的危险因素,应用受试者工作特征曲线(ROC)评估血清PTX3和sTWEAK水平预测死亡的效能。结果 在随访期间,本组患者生存69例,死亡39例;死亡组患者血清TNF-α、IL-6、CRP、PTX3和sTWEAK水平显著高于生存组分别为(68.3±11.2)ng/L对(39.8±19.0)ng/L,(918.3±148.7)ng/L对 (249.6±51.2)ng/L,(5.6±0.3)mg/L 对(2.4±0.9)mg/L,(19.7±3.3)ng/mL对 (11.6±0.6)ng/mL和(1459.0±215.3)ng/L 对 (549.5±23.5)ng/L,P<0.05],而死亡组患者SGNA评分显著低于生存组(16.5±8.6)分 对(23.2±7.6)分,P<0.05];多因素分析表明SGNA及血清PTX3和sTWEAK水平是影响失代偿期乙型肝炎肝硬化患者死亡的独立危险因素(分别为OR=1.366、95%CI:1.036~1.801;OR=1.939、95%CI:1.409~2.670和OR=2.891、95%CI:1.909~4.380,P<0.05);SGNA及血清PTX3和sTWEAK水平对失代偿期乙型肝炎肝硬化患者死亡均具有预测价值,三组比较,显示PTX3的AUC最大(AUC=0.868、95%CI:0.823~0.912),sTWEAK次之(AUC=0.753、95%CI:0.690~0.816),而SGNA的最小(AUC=0.675、95%CI:0.606~0.743),血清PTX3水平预测死亡的灵敏度和特异度均最高,分别为83.52%和74.16%。结论 失代偿期乙型肝炎肝硬化死亡患者血清PTX3和sTWEAK水平显著升高,检测其水平有助于早期预测失代偿期乙型肝炎肝硬化患者预后,值得临床进一步研究。

Clinical value of serum PTX3 and sTWEAK in predicting death of patients with decompensated hepatitis B cirrhosis

Objective The aim of this study was to investigate the clinical value of serum pentraxin 3(PTX3)and soluble tumor necrosis factor-like weak inducer of apoptosis(TWEAK)levels in predicting death of patients with decompensated hepatitis B cirrhosis.Methods 108 patients with decompensated hepatitis B-induced liver cirrhosis were admitted to our hospital between January 2016 and June 2019,and all were followed-up for 6 months.The protein-energy wasting(PEW)was evaluated,and serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C-reactive protein(CRP)as well as serum PTX3 and sTWEAK levels were detected.Results 39 patients with decompensated hepatitis B-induced liver cirrhosis out of our series died,and 69 survived during six month follow-up period;serum TNF-α,IL-6,CRP,PTX3 and sTWEAK levels in dead group at presentation were significantly higher than those in the survival group(68.3±11.2)ng/L vs.(39.8±19.0)ng/L,(918.3±148.7)ng/L vs.(249.6±51.2)ng/L,(5.6±0.3)mg/L vs.(2.4±0.9)mg/L,(19.7±3.3)ng/mL vs.(11.6±0.6)ng/mL,and(1459.0±215.3)ng/L vs.(549.5±23.5)ng/L,respectively,all P<0.05],while the SGNA score in the dead group was significantly lower than that in the survival group(16.5±8.6)vs.(23.2±7.6),P<0.05];the multivariate Logistic analysis showed that the SGNA,serum PTX3 and sTWEAK levels were the independent risk factors for death in patients with decompensated hepatitis B cirrhosis(OR=1.366,95%CI:1.036-1.801;OR=1.939,95%CI:1.409-2.670,OR=2.891;95%CI:1.909-4.380,P<0.05);the SGNA,serum PTX3 and sTWEAK levels had predictive value for the death of patients with decompensated hepatitis B cirrhosis with the area under ROC(AUC)of serum PTX3 level the largest(AUC=0.868,95%CI:0.823-0.912),of serum sTWEAK the relative large(AUC=0.753,95%CI:0.690-0.816)and the SGNA smallest(AUC=0.675,95%CI:0.606-0.743),and the sensitivity and specificity of serum PTX3 level were the highest,83.52%and 74.16%,respectively.Conclusion Serum levels of PTX3 and sTWEAK in dead patients with decompensated cirrhosis elevate early,and the determination of them might help predict the prognosis of patients with decompensated hepatitis B cirrhosis in the early stage,which is worthy of clinical verification.