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。

Prognostic efficacy of serum keratin 18 in patients with hepatitis B virus-related acute on chronic liver failure

Objective To investigate the prognostic efficacy of serum keratin 18 in patients with hepatitis B virus-related acute on chronic liver failure（HBV-ACLF）. Methods One hundred patients with HBV-ACLF,30 with chronic hepatitis B and 30 healthy persons were recruited in our hospital between January 2015 and January 2017,and serum K18 （M30 and M65） levels were measured by enzyme-linked immunosorbent assay. All patients were followed-up for 3 months. The prognostic efficacy of M30/M65 ratio and the end stage liver disease model（MELD） were assessed by AUC. Results Serum M30,M65 and M30/M65 ratio in patients with ACLF at presentation were（1.0±0.1） lg U/L,（3.4±0.3） lg U/L and （0.3±0.1）,significantly different as compared to 【（2.1±0.1） lg U/L,（3.3±0.2） lg U/L and （0.6±0.0）,respectively,P<0.05】 in patients with CHB or【（2.1±0.1） lg U/L,（2.1±0.1） lg U/L and（1.0±0.2）,respectively,P<0.05】 in control persons;MELD score in 68 survivals was（18.2±.0）,significantly lower than【（26.1±3.3）,P<0.05】 in 32 dead,serum M65 level was （2.9±0.2） lg U/L,much lower than （4.1±0.5） lg U/L,P<0.05] in the dead,and M30/M65 ratio was （0.4±0.1）,significantly higher than 【（0.2±0.1）,P<0.05】 in the dead group;the cut-off-value of MELD in forecasting the prognosis of patients with ACLF was 23.21,and its AUC was 0.650,with the sencitivity（Se） of 85.5%,specificity（Sp） of 65.0% and accuracy （Ac） of 72.0%,while the cut-off-value of M30/M65 ratio was 0.30,and its AUC was 0.875,with the Se of 94.5%,Sp of 85.0% and Ac of 85.0%,much superior to MELD score（P<0.05）. Conclusion Serum K18（M30 and M65） level is related to the severity of liver diseases,and early detection of serum M30/M65 might be helpful in predicting the prognosis of patients with HBV-ACLF.