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目的探索可溶性CD163(sCD163)在不同肝脏疾病谱中的水平,以及对慢加急性肝功能衰竭短期预后的预测价值。方法前瞻性纳入慢性乙型肝炎、肝硬化及慢加急性肝功能衰竭患者作为学习队列,检测血清CD163水平;回顾性纳入连续的慢加急性肝功能衰竭患者验证sCD163水平对慢加急性肝功能衰竭的28 d生存期的预测。结果纳入171例患者进入学习队列。慢加急性肝功能衰竭患者sCD163高于慢性乙型肝炎或者肝硬化患者。sCD163水平与血清总胆红素(Rs=0.6199,P<0.01)、凝血酶原时间国际标准化率(Rs=0.5751,P<0.01)正相关,与外周血红细胞计数(Rs=-0.2194,P=0.0232)、纤维蛋白原水平(Rs=-0.3898,P<0.01)负相关。sCD163水平(HR=2.601,P=0.01)与肝性脑病(HR=5.003,P<0.01)是28 d生存率的独立预测因素,模型具有较好的预测能力(曲线下面积=0.83,P<0.01),并在回顾性队列中得到验证。结论血清sCD163水平是预测慢加急性肝功能衰竭短期预后的优良候选指标。
Objective To explore the level of soluble CD163 (sCD163) in different liver disease spectrum and predict the short-term prognosis of acute and chronic liver failure. Methods Patients with chronic hepatitis B, cirrhosis and acute liver failure were prospectively enrolled in the study cohort to detect serum CD163 levels. The patients with chronic slow-onset and acute liver failure were retrospectively retrospectively analyzed for the effect of sCD163 on acute and chronic liver failure Prediction of 28-year survival. Results 171 patients enrolled in the study cohort. Patients with acute and chronic liver failure have higher sCD163 than those with chronic hepatitis B or cirrhosis. The level of sCD163 was positively correlated with the serum total bilirubin (Rs = 0.6199, P <0.01) and the international normalization rate of prothrombin time (Rs = 0.5751, P <0.01) 0.0232), fibrinogen level (Rs = -0.3898, P <0.01). The predictive value of sCD163 level (HR = 2.601, P = 0.01) and hepatic encephalopathy (HR = 5.003, P <0.01) were independent predictive factors for 28-day survival. 0.01) and was validated in a retrospective cohort. Conclusion Serum sCD163 level is a good candidate for predicting the short-term prognosis of patients with acute and chronic liver failure.