慢加急性肝衰竭患者血清二胺氧化酶水平及其临床意义探讨*

目的 探讨乙型肝炎相关的慢加急性肝衰竭（ACLF）患者血清二胺氧化酶（DAO）水平及其评估患者预后的价值。方法 2014年8月~2017年4月我院收治的104例ACLF患者,在治疗60 d内,生存64例,死亡40例。采用酶联免疫吸附法检测血清DAO水平,采用二元Logistic回归分析影响患者预后的因素。结果 生存患者血清DAO水平为（15.1±4.8） ng/mL,显著低于死亡患者（68.4±25.4） ng/mL,P<0.05];单因素分析显示年龄、TBIL、AST、ALT、INR、ALB、Cr、MEID评分、WBC、自发性细菌腹膜炎、肝性脑病、腹水和肝硬化与患者预后结局相关,多因素回归分析显示,MELD评分、年龄和血清DAO水平为影响患者预后的独立危险因素;DAO≥48.7 ng/mL与DAO<48.7 ng/mL患者生存率分别为50.0%和77.3%,差异有统计学意义（P<0.05）,MELD≥26.1分与MELD<26.1分患者生存率分别为45.5%和79.6%,差异有统计学意义（P<0.05）,年龄≥40岁与年龄<40岁的患者生存率分别为50.8%和79.5%,差异有统计学意义（P<0.05）。结论 血清DAO水平也可以判断ACLF患者预后,为判断肝衰竭患者预后增加了一个可应用的指标,其作用还有待于进一步研究。

Serum diamine oxidase level in patients with hepatitis B-induced acute-on-chronic liver failure

Objective To investigate the changes of implication of serum diamine oxidase（DAO） level in patients with hepatitis B-induced acute-on-chronic liver failure（ACLF）. Methods A total of 104 patients with ACLF were admitted to our hospital between August 2014 and April 2017,and 64 patients survived and 40 died in 60 day observation. Serum DAO levels were detected by ELISA,and the factors affecting the prognosis of patients were analyzed by Logistic regression analysis. Results Serum DAO level in the survival group was （15.1±4.8） ng/mL,significantly lower than（68.4±25.4） ng/mL （P<0.05） in the fatal group;univariate analysis showed that serum TBIL,AST,ALT,INR,ALB,Cr,and MEID score,WBC,spontaneous bacterial peritonitis,hepatic encephalopathy,ascites,as well as cirrhosis were associated with the bad prognosis,and multivariate regression analysis demonstrated that high MELD scores,high DAO levels and patients’ age were the independent risk factors for death of patient with ACLF;the survival rates in patients with serum DAO≥48.7 ng/mL and with serum DAO<48.7 ng/mL were 50.0% and 77.3% （x2=7.977,P=0.005）,the survival rates in patients with MELD≥26.1 and with MELD<26.1 were 45.5% and 79.6%,and the survival rates in patients greater than 40-yr-old and under 40 were 50.8% and 79.5%,respectively （all P<0.05）. Conclusion Serum DAO levels might be used as a new parameter for predicting the prognosis of patients with ACLF,which needs further investigation.