CAJ | 학술논문

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。
목적：혈장유리DNA（cfDNA）적승고재다충질병상태하（종류、외상등）여불량예후상관。진일보연구cfDNA재을형만가급성간쇠갈（HBV-ACLF）중적진단화치료작용。방법38명입주ICU적HBV-ACLF환자，근거출원시예후，분위호전조여악화조。수집주원시화출원시외주혈표본，응용real-time PCR정량검측혈장cfDNA，동시계산환자MELD분치。결과주원시호전조환자cfDNA수평저우악화조환자（P=0.044），재출원시량조차이경가명현（P<0.001）。단주원시량조MELD분치무현저차별。환자cfDNA수평여MELD분치、TBIL급INR등수평유현저상관。통과회제ROC곡선발현，출원시cfDNA대HBV-ACLF적진단능력최강（곡선하면적0.960），수후시출원화입원cfDNA수평적차치（ΔcfDNA）（곡선하면적0.923）화주원시cfDNA수평（곡선하면적0.667）。결론cfDNA유희망성위HBV-ACLF신적진단화예후지표。
Objective Cell-free DNA (cfDNA) was shown to be a prognostic marker for diverse pathological states in the Intense Care Unit, but little is known of the role of cfDNA in HBV-related acute-on-chronic liver failure (ACLF). We hypothesize that cfDNA can also be a promising prognostic as well as a diagnostic marker in patients with HBV-related ACLF. Methods Thirty-eight patients with HBV-related ACLF admitted in the Intense Care Unit were enrolled in the study. The patients were divided, according to the improvement of liver function at discharge, into favorable prognosis group (group 1, n=17) and poor prognosis group (group 2, n=19). Plasma samples were collected from each patient at hospitalization and at discharge to measure cfDNA by real-time quantitative PCR. MELD score was calculated at the same time points. Results The average level of cfDNA of group 1 was lower than that of group 2 both at the time of hospitalization (P=0.044) and at discharge (P<0.001). There was no difference in MELD score between the two groups at hospitalization. Significant correlations were found of cfDNA levels with the MELD score, TBIL, CRE and INR both at hospitalization (γ=0.662, P<0.001;γ=0.356, P=0.033;γ=0.360, P=0.031;γ=0.570, P<0.001, respectively) and at discharge (γ=0.854, P<0.001;γ=0.821, P<0.001;γ=0.650, P<0.001;γ=0.638, P<0.001, respectively). The ROC curve showed that cfDNA level at discharge was optimal in diagnosing ACLF with an area under curve (AUC) value of 0.96, followed by?cfDNA (AUC value of 0.923) and cfDNA level at hospitalization (AUC value of 0.667). The MELD scores had an AUC value of only 0.545 at the time of hospitalization. Conclusion cfDNA may serve as a promising prognostic and diagnostic marker for predicting in-hospital prognosis of HBV-related ACLF within 2 to 8 weeks.