目的:探讨ALST(人工肝支持治疗)对慢加急性肝衰竭(ACLF)患者炎性因子及预后的影响。
方法:入院的ACLF患者的数据。2兰州市人民医院2020年6月至2023年1月的回顾性分析。比较ALST前后患者的ALT(丙氨酸氨基转移酶),AST(天冬氨酸氨基转移酶),TBil(总胆红素),Cr(肌酐),INR(国际标准化比率),MELD(终末期肝病模型)评分,以及TNF-α(肿瘤坏死因子-α),IL-33(白介素-33),和MIP-1α(巨噬细胞炎性蛋白-1α)水平。采用受试者工作特征(ROC)曲线分析上述指标对患者90d死亡率的预测效果。
结果:治疗后,ALT的水平,AST,TBil,Cr,INR,MELD评分明显低于治疗前(均P<0.001)。此外,TNF-α的水平,IL-33和MIP-1α显著低于治疗前(P均<0.001)。TNF-α,IL-33、MIP-1α与治疗前后MELD评分呈正相关(均P<0.01)。TNF-α,IL-33,MIP-1α,死亡组MELD评分明显高于存活组(均P<0.01)。ROC曲线显示MELD(AUC=0.857),TNF-α(AUC=0.836),IL-33(AUC=0.749),MIP-1α(AUC=0.746)在预测患者90天死亡率方面具有很高的疗效。
结论:ALST能显著降低TNF-α,ACLF患者的IL-33和MIP-1α水平,和术后TNF-α,IL-33和MIP-1α水平对患者预后有很高的预测价值。
OBJECTIVE: To investigate the effect of ALST (artificial liver support treatment) on inflammatory factors and prognosis in patients with ACLF (acute-on-chronic liver failure).
METHODS: Data of ACLF patients admitted to the No. 2 People\'s Hospital of Lanzhou from June 2020 to January 2023 were retrospectively analyzed. Patients were compared before and after ALST in terms of ALT (Alanine Aminotransferase), AST (Aspartate Aminotransferase), TBil (Total Bilirubin), Cr (Creatinine), INR (International Normalized Ratio), MELD (Model for End-Stage Liver Disease) scores, as well as TNF-α (Tumor Necrosis Factor-α), IL-33 (Interleukin-33), and MIP-1α (Macrophage Inflammatory Protein-1 α) levels. The ROC (receiver operating characteristic) curve was used to analyze the efficacy of the above indicators in predicting 90-day mortality in patients.
RESULTS: After the treatment, the levels of ALT, AST, TBil, Cr, INR, and MELD score were significantly lower than those before treatment (all P<0.001). Also, the levels of TNF-α, IL-33, and MIP-1α were substantially lower than those before treatment (all P<0.001). TNF-α, IL-33, and MIP-1α were positively correlated with MELD score before and after the treatment (all P<0.01). TNF-α, IL-33, MIP-1α, and MELD score were significantly higher in the death group than in the survival group (all P<0.01). The ROC curves showed that MELD (AUC=0.857), TNF-α (AUC=0.836), IL-33 (AUC=0.749), and MIP-1α (AUC=0.746) had high efficacy in predicting patients\' 90-day mortality.
CONCLUSIONS: ALST can significantly reduce TNF-α, IL-33, and MIP-1α levels in patients with ACLF, and postoperative TNF-α, IL-33, and MIP-1α levels have a high predictive value for patients\' prognosis.