HBV-ACLF患者血清FT3水平变化及其临床意义探讨*

目的 探索应用游离三碘甲状腺原氨酸(FT3)水平预测乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者病情严重程度的价值。方法 纳入2018年9月～2020年2月我院住院的HBV-ACLF患者122例,使用雅培 i2000SR 全自动化学发光分析仪检测血清FT3水平。应用受试者工作特征曲线下面积(AUROC)分析血清FT3水平预测MELD评分的效能。结果 45例肝衰竭早期、46例中期和31例晚期患者血清FT3水平分别为(2.73±0.57)pmol/L、(2.55±0.49)pmol/L和(2.29±0.42)pmol/L,组间差异显著(P < 0.001);MELD<30、30≤MELD<40、MELD≥40组血清FT3水平分别为(2.77±0.14)pmol/L、(2.32±0.13)pmol/L和(2.08±0.09)pmol/L(P < 0.001),提示随着衰竭器官数量的逐渐增多或MELD评分升高,血清FT3水平逐渐降低;经ROC曲线分析,结果显示FT3(1-AUROC)为0.739(0.686～0.792),而Ln(TBIL)、Ln(Cr)和Ln(INR)的AUROC分别为0.748(0.696～0.800)、0.632(0.562～0.702)和0.933(0.903～0.963),P<0.001],提示血清FT3预测MELD评分高的效能仅次于INR,而与血清总胆红素相当。结论 应用血清FT3水平预测HBV-ACLF患者病情严重程度具有一定的临床意义,血清FT3水平太低意味着病情严重。

Serum FT3 level changes in patients with HBV-ACLF

Objective The aim of this study was to investigate the implication of serum free triiodothyronine(FT3)in patients with hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF).Methods 122 patients with HBV-ACLF were admitted in Beijing You'an Hospital between September 2018 and February 2020,and serum FT3 levels were detected.The area under the receiver operating characteristic curve(AUROC)was applied to analyze the efficacy of serum FT3 for predicting the model for end-stage liver disease(MELD)score.Result Serum FT3 levels in 45 patients with HBV-ACLF early stage,in 46 patients with middle stage and in 31 patients with late stage were(2.73±0.57)pmol/L,(2.55±0.49)pmol/L and(2.29±0.42)pmol/L,significantly different among them(P<0.001);serum FT3 levels in patients with MELD<30,30≤MELD<40 and MELD≥40 were(2.77±0.14)pmol/L,(2.32±0.13)pmol/L and(2.08±0.09)pmol/L(P<0.001),suggesting the tends of increased MELD score as serum FT3 levels gradually decreased;the ROC analysis showed that the 1-AUROC of serum FT3 was 0.739(0.686-0.792),while the 1-AUROCs of total serum bilirubin(TSB)levels,of serum creatinine and international normalized ratio(INR)of prothrombin time were0.748(0.696-0.800),0.632(0.562-0.702)and 0.933(0.903-0.963),respectively,P<0.001],suggesting that the efficacy of serum FT3 levels was equal to TSB.Conclusion Serum FT3 levels decrease in patients with HBV-ACLF,which might be a new indicator to judge the severity of the disease.