【摘要】 目的探究血清趋化素(Chemerin)和中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在慢加急性肝衰竭(ACLF)患者中的表达水平,以及其对于预后评估的意义。方法选择2015年6月至2018年9月在绵阳市第三人民医院就诊的118例ACLF患者作为研究对象(ACLF组),另选择58例同期健康体检者作为对照组。采用酶联免疫吸附法检测两组血清Chemerin和NGAL的表达水平,并分析其与ACLF患者预后的关系。结果 ACLF组患者血清Chemerin表达水平低于对照组,NGAL表达水平高于对照组,差异均有统计学意义(P均<0.05)。死亡组患者血清Chemerin表达水平低于生存组,NGAL表达水平高于生存组,差异均有统计学意义(P均<0.05)。单指标评估ACLF患者预后时,Chemerin的评估效能高于NGAL,但差异无统计学意义(P>0.05)。Chemerin联合NGAL评估ACLF患者预后的效能高于单指标诊断(P均<0.05)。Chemerin和NGAL单指标评估ACLF患者预后的效能均低于终末期肝病模型(MELD)评分,而Chemerin联合NGAL评估预后的效能高于MELD评分,但差异均无统计学意义(P均>0.05)。ACLF患者中,Chemerin≤79.64 ng/mL者的平均生存时间短于Chemerin>79.64 ng/mL者,NGAL≤2.23 ng/mL者的平均生存时间长于NGAL>2.23 ng/mL者,差异均有统计学意义(P均<0.05)。Cox单因素及多因素分析结果显示,合并感染、Chemerin≤79.64 ng/mL和NGAL>2.23 ng/mL的ACLF患者预后较差。结论血清Chemerin和NGAL的表达水平与ACLF患者的预后密切相关。联合检测血清Chemerin和NGAL的表达水平可辅助评价ACLF患者的预后。更多还原

【Abstract】 Objective This paper aims to investigate the serum of Chemerin and NGAL in patients with acute-on-chronic liver failure(ACLF) and their significance in prognosis evaluation. Methods A total of 118 patients with ACLF who were admitted to the Third People′s Hospital of Mianyang from June 2015 to September 2018 were enrolled in the study(ACLF group), while 58 healthy subjects were selected as the control group. The expression of serum Chemerin and the NGAL were measured by enzyme-linked immunosorbent assay while the relationship between Chemerin and NGAL and the prognosis of patients with ACLF was analyzed. Results The expression of serum Chemerin in the ACLF group was lower than that in the control group, and the expression of NGAL was higher than that in the control group(P<0.05). The expression of serum Chemerin in the death group was lower than that in the survival group, while the expression of NGAL was higher than that in the survival group(P<0.05). Chemerin had a higher diagnostic efficacy than NGAL in the diagnosis of patients, but the difference was not statistically significant(P>0.05). The efficacy of Chemerin and NGAL in the diagnosis of patients with ACLF was higher than that of Chemerin or NGAL alone(P<0.05). The efficacy of Chemerin and NGAL in the diagnosis of patients with ACLF was lower than that of MELD, but the difference was not statistically significant(P>0.05). The efficacy of Chemerin and NGAL in the diagnosis of patients with ACLF was higher than that of MELD, but the difference was not statistically significant(P>0.05). The mean survival time of patients with ACLF with Chemerin ≤79.64 ng/mL was lower than that of patients with ACLF with Chemerin>79.64 ng/mL(P<0.05). The mean survival time of ACLF patients with NGAL≤2.23 ng/mL was higher than that of patients with ACLF with NGAL>2.23 ng/mL(P<0.05). The Cox single-factor and multi-factor analysis showed that patients with ACLF with concomitant infection, Chemerin ≤79.64 ng/mL, and NGAL>2.23 ng/mL had a poor prognosis. Conclusions Serum Chemerin and NGAL are closely related to the prognosis of patients with ACLF. Combined detection of serum Chemerin and NGAL can be helpful in evaluating the prognosis of patients with ACLF.更多还原