血清甲胎蛋白、p62及LC3-Ⅱ在HBV相关慢加急性肝衰竭预后评估中的应用

肝脏 ›› 2023, Vol. 28 ›› Issue (12): 1418-1422.

血清甲胎蛋白、p62及LC3-Ⅱ在HBV相关慢加急性肝衰竭预后评估中的应用

方绕红, 尚高霞, 尹鹏燕, 张世德, 陈梅, 李庆蓉

661000 个旧云南省滇南中心医院(红河州第一人民医院)医学检验科(方绕红,尹鹏燕,张世德),麻醉科手术室(尚高霞),感染科(陈梅);650000 云南昆明医科大学第二附属医院检验科(李庆蓉)

收稿日期:2023-09-05 出版日期:2023-12-31 发布日期:2024-03-01
基金资助:
云南省科技厅基础研究专项面上项目(202101AT070256)

The application of serum alpha fetoprotein, p62, and microtubule associated protein 1 light chain 3- Ⅱ in the prognostic evaluation of patients with HBV-related acute-on-chronic liver failure

FANG Rao-hong¹, SHANG Gao-xia², YIN Peng-yan¹, ZHANG Shi-de¹, CHEN Mei³, LI Qing-rong⁴

1. Laboratory Medical, South Central Hospital of Yunnan Province (The First People's Hospital of Honghe State),Gejiu 661000,China;
2. Anesthesiology operating room, South Central Hospital of Yunnan Province (The First People's Hospital of Honghe State),Gejiu 661000,China;
3. Infectious Diseases Department, South Central Hospital of Yunnan Province (The First People's Hospital of Honghe State),Gejiu 661000,China;
4. Laboratory Department, The Second Affiliated Hospital of Kunming Medical University, Kunming 650000, China

Received:2023-09-05 Online:2023-12-31 Published:2024-03-01

摘要/Abstract

摘要： 目的探讨血清甲胎蛋白(AFP)、自噬相关蛋白p62及微管相关蛋白1轻链3-Ⅱ(LC3-Ⅱ)在HBV相关慢加急性肝衰竭(HBV-ACLF)患者预后评估中的应用价值。方法回顾性选取2020年1月—2023年1月云南省滇南中心医院(红河州第一人民医院)收治的102例HBV-ACLF患者作为观察组,另选取同期收治的慢性乙型肝炎患者、同期健康体检者各50例分别作为疾病对照组和健康对照组。测定并对比3组的血清AFP、p62及LC3-Ⅱ水平。对观察组患者的预后情况进行随访,对比预后良好与预后不良患者的血清AFP、p62及LC3-Ⅱ水平,并通过受试者工作特征曲线(ROC)分析血清AFP、p62及LC3-Ⅱ水平对HBV-ACLF患者预后良好的预测效能。结果 3组的血清AFP、LC3-Ⅱ均有观察组＞疾病对照组＞健康对照组,血清p62有观察组＜疾病对照组＜健康对照组,组间两两比较差异均有统计学意义(P<0.05)。随访显示观察组死亡31例(预后不良),生存71例(预后良好),病死率30.39%。预后良好组的血清AFP、p62水平高于预后不良组,血清LC3-Ⅱ水平低于预后不良组(P<0.05)。ROC曲线显示,当AFP值＞115.65 ng/mL、p62＞1.12 ng/mL、LC3-Ⅱ＜53.07时,对HBV-ACLF患者预后良好均有一定的预测价值(AUC均＞0.7)。与3项指标单用比较,3项联合对HBV-ACLF患者预后良好的诊断效能更高(AUC=0.878),诊断灵敏度、特异度分别为92.17%和85.68%。结论血清AFP、p62及LC3-Ⅱ均对HBV-ACLF患者预后有一定的预测价值,3项联合的预测效能更高。

Abstract: Objective To explore the application value of serum alpha fetoprotein (AFP), autophagy associated protein p62, and microtubule associated protein 1 light chain 3- Ⅱ (LC3- Ⅱ) in the prognostic evaluation of patients with HBV-related acute-on-chronic liver failure (HBV-ACLF).Methods This is a retrospective study that was conducted on 102 HBV-ACLF patients admitted from January 2020 to January 2023 in South Central Hospital of Yunnan Province as the observation group. Additionally, 50 hepatitis B patients admitted during the same period of time and 50 healthy individuals were selected as the disease control group and healthy control group, respectively. The levels of serum AFP, p62, and LC3- Ⅱ were measured and compared among three groups. The prognosis of patients in the observation group were followed up, and the serum AFP, p62 and LC3-Ⅱ levels of patients with good and poor prognosis were compared. The predictive efficacy of serum AFP, p62, and LC3- Ⅱ levels on the prognosis of HBV-ACLF patients were analyzed with the receiver operating characteristic curve (ROC) method.Results The serum AFP and LC3-Ⅱ levels were observed in the observation group>disease control group>healthy control group, and the serum p62 levels were observed in the observation group<disease control group<healthy control group. Pairwise comparisons between the groups showed statistically significant differences (P<0.05). During follow-up, 31 cases died (i.e., with poor prognosis) and 71 cases survived (i.e., with good prognosis) in the observation group, with a mortality rate of 30.39%. The serum AFP and p62 levels in the group with good prognosis were higher than those in the group with poor prognosis, whereas the serum LC3-II levels were lower than those in the group with poor prognosis (P<0.05). The ROC curve analysis showed that when the AFP value was >115.65 ng/mL, p62 >1.12 ng/mL, and LC3-Ⅱ <53.07, it had certain predictive value for the good prognosis of HBV-ACLF patients (AUC>0.7). When compared with the single use of three indicators, the combined use of three indicators had a higher diagnostic efficacy for HBV-ACLF patients with good prognosis (AUC=0.878), with diagnostic sensitivity and specificity of 92.17% and 85.68%, respectively.Conclusion Serum AFP, p62, and LC3- Ⅱ all have certain predictive value for the prognosis of HBV-ACLF patients, and the combined predictive efficacy of the three items is higher.

Key words: Alpha fetoprotein, Autophagy related proteins, Microtubule associated protein 1 light chain 3-II, Chronic hepatitis B, Acute-on-chronic liver failure

方绕红, 尚高霞, 尹鹏燕, 张世德, 陈梅, 李庆蓉. 血清甲胎蛋白、p62及LC3-Ⅱ在HBV相关慢加急性肝衰竭预后评估中的应用[J]. 肝脏, 2023, 28(12): 1418-1422.

FANG Rao-hong, SHANG Gao-xia, YIN Peng-yan, ZHANG Shi-de, CHEN Mei, LI Qing-rong. The application of serum alpha fetoprotein, p62, and microtubule associated protein 1 light chain 3- Ⅱ in the prognostic evaluation of patients with HBV-related acute-on-chronic liver failure[J]. Chinese Hepatolgy, 2023, 28(12): 1418-1422.

参考文献

[1] 李佳琪, 李君. 慢加急性肝衰竭:定义,诊断与发病机制.中华肝脏病杂志,2022,30(02):121-126.
[2] 李子月, 杨士田, 吴玲玲, 等. 乙型肝炎病毒相关慢加急性肝衰竭患者预后危险因素分析及预后模型建立. 中华传染病杂志,2019,37(12):737-741.
[3] 张舒阳, 毕研贞, 刘守胜, 等. 慢性乙型肝炎与HBV相关慢加急性肝衰竭患者血浆外泌体差异miRNA的生物信息学分析. 临床肝胆病杂志,2023,39(8):1848-1856.
[4] 蔡明豪, 谢青. 慢加急性肝衰竭研究迈入新阶段. 肝脏,2019,24(1):4-6.
[5] 秦森, 汤善宏, 王显红, 等. 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. 中华肝脏病杂志,2020,28(1):69-72.
[6] 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版). 实用肝脏病杂志,2019,22(2):164-171.
[7] 谢艳迪, 封波, 饶慧瑛.《慢性乙型肝炎防治指南(2022年版)》解读. 临床肝胆病杂志,2023,39(7):1553-1559.
[8] 贾学友, 晋晓丽, 戴进前. 基于Cox风险回归预测模型判断HBV-ACLF短期预后的价值. 中西医结合肝病杂志,2022,32(4):357-360.
[9] Xiao LL, Wu XX, Chen JJ, et al. Progress in hepatitis B virus-related acute-on-chronic liver failure treatment in China: A large, multicenter, retrospective cohort study using a propensity score matching analysis. Hepatobiliary Pancreat Dis Int,2021,20(6):535-541.
[10] Hanif H, Ali MJ, Susheela AT, et al. Update on the applications and limitations of alpha-fetoprotein for hepatocellular carcinoma. World J Gastroenterol,2022,28(2):216-229.
[11] 吴红, 李浩, 汤善宏. 甲胎蛋白在肝衰竭患者预后判断中的作用. 临床肝胆病杂志,2021,37(11):2706-2709.
[12] 李超伟, 房太勇. 自噬在常见肝脏疾病中的作用及机制. 检验医学与临床,2023,20(7):981-983.
[13] 沈美佳, 孙力超, 张国强. 脓毒症小鼠肝细胞自噬与LC3及P62表达的实验研究. 中华急诊医学杂志,2019,28(4):467-472.
[14] 罗羽鸥, 杨晓玲, 李川. HBV-ACLF患者血清Beclin1、LC3-Ⅱ的表达水平及其临床意义. 标记免疫分析与临床,2020,27(4):586-590.
[15] 高伟, 高虹, 尹春梅, 等. 血清GP73与p62测定对HBV相关慢加急性肝衰竭患者短期预后的预测价值比较. 中华肝脏病杂志,2021,29(9):855-860.