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血清炎症标志物与肝静脉压力梯度相关性的临床评价 预览 被引量:1

Clinical evaluation of the correlation between serum soluble cytokines and hepatic venous pressure gradient
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摘要 目的 通过评估外周血炎症标志物水平与肝静脉压力梯度(hepatic venous pressure gradient,HVPG)的相关性,探索其作为无创诊断对门静脉高压的临床价值。方法 纳入2016年1月至2017年8月因肝硬化门脉高压食管胃静脉曲张入住复旦大学附属中山医院并行HVPG压力测定的患者,分析肝功能Child评分、MELD评分、外周血IL-1β、s IL-2R、IL-6、IL-8、IL-10和TNF-α等相关指标与HVPG的相关性,并探究潜在标志物的临床诊断效能。结果 共纳入134例进行HVPG测定和炎症指标检测的肝硬化食管胃静脉曲张患者,HVPG平均值为(16. 0±0. 5)mm Hg,其中有104例(77. 6%)患者HVPG≥12 mm Hg。Spearman相关性分析发现,肝硬化门脉高压患者肝功能Child评分、外周血s IL-2R和TNF-α与HVPG呈正相关性(P 〈0. 05),与年龄、MELD评分及其他炎症标志物无显著相关性(P〉0. 05)。Logistic回归发现,仅s IL-2R与HVPG独立相关(r=0. 416,P 〈0. 0001)。在诊断HVPG≥12 mm Hg时,IL-2R的AUC值为(0. 772±0. 044)(95%CI:0. 686~0. 857,P 〈0. 0001),临界值为475 pg/ml,敏感度为51. 9%,特异度为93. 1%,阳性预测值为96. 4%,阴性预测值为35. 1%。结论 肝硬化门脉高压食管胃静脉曲张的患者,外周血s IL-2R浓度水平与HVPG呈独立正相关,可能作为门脉压力无创诊断的血清标志物。 Objective To investigate the correlation between peripheral serum soluble cytokines and hepatic venous pressure gradient (HVPG) , and to explore whether the inflammatory biomarkers could serve as a non-invasive test to predict portal pressure. Methods From Jan. 2016 to Aug. 2017, cirrhotic patients with gastroesophageal varices who underwent HVPG in Zhongshan Hospital, Fudan University were included. The correlations of HVPG with Child Pugh score, MELD score, serum level of IL-1β, sIL-2R, IL-6, IL-8, IL-10, TNF-α were analyzed. Results A total of 134 cirrhotic patients were included with the mean HVPG of (16.0 _+ 0.5 ) mmHg. Among them, there were 104 patients (77.6%) with the HVPG≥ 12 mmHg. Spearman' s correlation analysis showed that Child score, sIL-2R and TNF-α were positively correlated with HVPG (P 〈 0. 05). There were no significant correlations of HVPG with age, MELD score and other inflammatory biomarkers(P 〈 0.05). Multivariate Logistic regression analysis showed that sIL-2R was independently conelated with HVPG (r = 0. 416, P 〈 0. 0001 ). In HVPG ≥ 12 mmHg prediction, area under the curve (AUC) was (0. 772 ±0. 044) (95% CI: 0. 686 -0. 857 ; P 〈0. 0001 ) and the sensitivity was 51.9%, the specificity was 93.1% , and the positive predictive value was 96.4% and the negative predictive value was 35.1%. Conclusion Serum level of sIL-2R is independently correlated with HVPG in cirrhotic patients with gastroesophageal varices, and it would be the potential inflammatory biomarker tor noninvasive test to predict portal pressure.
作者 黄晓铨 张瑞 蒋颖溢 刘成凤 陈世耀 HUANG Xiaoquan, ZHANG Rui, JIANG Yingyi, LIU Chengteng, CHEN Shiyao(Department of Gastroenterology, Zhongshan Hospital, Fudan University, Evidence-based Medicine Center, Fudan University, Shanghai 200032, China)
出处 《胃肠病学和肝病学杂志》 CAS 2018年第9期991-994,共4页 Chinese Journal of Gastroenterology and Hepatology
基金 上海市科学技术委员会科技创新基金资助项目(15411950501)
关键词 肝硬化门脉高压 炎症标志物 肝静脉压力梯度 无创诊断 Cirrhotic portal hypertension Inflammatory biomarker Hepatic venous pressure gradient Non-invasive diagnosis
作者简介 黄晓铨,博士,住院医师,研究方向:慢性肝病、系统炎症与肠道微生态。E—mail:huang.xiaoquan@zs-hospital.sh.cn;通讯作者:陈世耀,博士生导师,主任医师,研究方向:胃肠病肝病的诊治、内窥镜诊治。E-mail:chen.shiyao@zs-hospital.sh.cn
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