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目的血浆游离DNA(cfDNA)的升高在多种疾病状态下(肿瘤、外伤等)与不良预后相关。进一步研究cfDNA在乙型慢加急性肝衰竭(HBV-ACLF)中的诊断和治疗作用。方法 38名入住ICU的HBV-ACLF患者,根据出院时预后,分为好转组与恶化组。收集住院时和出院时外周血标本,应用real-time PCR定量检测血浆cfDNA,同时计算患者MELD分值。结果住院时好转组患者cfDNA水平低于恶化组患者(P=0.044),在出院时两组差异更加明显(P<0.001)。但住院时两组MELD分值无显著差别。患者cfDNA水平与MELD分值、TBIL及INR等水平有显著相关。通过绘制ROC曲线发现,出院时cfDNA对HBV-ACLF的诊断能力最强(曲线下面积0.960),随后是出院和入院cfDNA水平的差值(ΔcfDNA)(曲线下面积0.923)和住院时cfDNA水平(曲线下面积0.667)。结论 cfDNA有希望成为HBV-ACLF新的诊断和预后指标。
Objective Increased plasma free DNA (cfDNA) is associated with poor prognosis in a variety of disease states (tumors, trauma, etc.). To further study the cfDNA in the diagnosis and treatment of chronic hepatitis B and acute liver failure (HBV-ACLF). Methods 38 HBV-ACLF patients admitted to the ICU were divided into improvement group and worsening group according to the prognosis of discharge. Peripheral blood samples were collected during hospitalization and discharge. Quantitative real-time PCR was used to detect plasma cfDNA, meanwhile MELD scores of patients were calculated. Results The level of cfDNA in patients with remission was significantly lower than that in patients with worsening (P = 0.044). There was significant difference between the two groups when discharged (P <0.001). However, there was no significant difference in MELD scores between the two groups when hospitalized. The level of cfDNA in patients was significantly correlated with MELD scores, TBIL and INR levels. By plotting the ROC curve, cfDNA was found to be the most capable of diagnosing HBV-ACLF at discharge (area under the curve 0.960), followed by the difference in cfDNA levels between hospital discharge and admissions (ΔcfDNA) (area under the curve 0.923) and cfDNA Area under the curve 0.667). Conclusion cfDNA hopefully become a new diagnostic and prognostic indicator of HBV-ACLF.