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Prognostic value of M30/M65 for outcome of hepatitis B virus-related acute-on-chronic liver failure

World Journal of Gastroenterology 2014年第9期20卷 2403-2411页

作者： Su-Jun Zheng Shuang Liu Mei Liu Malcolm A McCrae Jun-Feng Li Yuan-Ping Han Chun-Hui Xu Feng Ren Yu Chen Zhong-Ping Duan Artificial liver Center Beijing Youan Hospital Capital Medical University The Pirbright Institute Pirbright GU24 ONF United Kingdom Department of Infectious diseases The First Hospital of Lanzhou University The Center for Growth Metabolism and Aging Research College of Life Sciences Sichuan University Institute of Hematology and Hospital of Blood diseases Chinese Academy of Medical Sciences and Peking Union of Medical College

AIM: To determine the prognostic value of circulating indicators of cell death in acute-on-chronic liver failure (ACLF) patients with chronic hepatitis B virus (HBV) infection as the single etiology. METHODS: Full length and caspase cleaved cytokeratin 18 (detected as M65 and M30 antigens) represent circulating indicators of necrosis and apoptosis. M65 and M30 were identified by enzyme-linked immunosorbent assay in 169 subjects including healthy controls (n = 33), patients with chronic hepatitis B (CHB, n = 55) and patients with ACLF (n = 81). According to the 3-mo survival period, ACLF patients were defined as having spontaneous recovery (n = 33) and non-spontaneous recovery which included deceased patients and those who required liver transplantation (n = 48). RESULTS: Both biomarker levels significantly increased gradually as liver disease progressed (for M65: P = 0.80) in identifying ACLF from CHB patients. Interestingly, it is worth noting that the M30/M65 ratio was significantly different between spontaneous and non-spontaneous recovery in ACLF patients (P = 0.032). The prognostic value of the M30/M65 ratio was compared with the Model for End-stage liver disease (MELD) and Child-Pugh scores at the 3-mo survival period, the AUC of the M30/M65 ratio was 0.66 with a sensitivity of 52.9% and the highest specificity of 92.6% (MELD:AUC = 0.71; sensitivity, 79.4%; specificity, 63.0%; Child-Pugh: AUC = 0.77; sensitivity, 61.8%; specificity, 88.9%). CONCLUSION: M65 and M30 are strongly associated with liver disease severity. The M30/M65 ratio may be a potential prognostic marker for spontaneous recovery in patient

关键词： Acute-on-chronic liver failure Chronic hepatitis B virus infection liver disease stage liver disease severity Serum M65 level Serum M30 level Prognostic value

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