中华传染病杂志
中華傳染病雜誌
중화전염병잡지
CHINESE JOURNAL OF INFECTIOUS DISEASES
2014年
8期
464-469
,共6页
王海燕%朱传武%方焕%钱峰%李明%罗湘蓉%张雪华%朱翔%沈秀娟
王海燕%硃傳武%方煥%錢峰%李明%囉湘蓉%張雪華%硃翔%瀋秀娟
왕해연%주전무%방환%전봉%리명%라상용%장설화%주상%침수연
肝功能衰竭%外周血单个核细胞%人端粒酶逆转录酶%RNA,信使%动态变化%预后
肝功能衰竭%外週血單箇覈細胞%人耑粒酶逆轉錄酶%RNA,信使%動態變化%預後
간공능쇠갈%외주혈단개핵세포%인단립매역전록매%RNA,신사%동태변화%예후
Liver failure%Peripheral blood mononuclear cells%Human telomerase reverse transcriptase%RNA,messenger%Dynamic change%Prognosis
目的 探讨肝功能衰竭患者在治疗过程中PBMC端粒酶反转录酶(hTERT) mRNA表达的动态变化及其对预后的评估价值.方法 苏州市第五人民医院肝病科2010年11月至2012年12月间收治的肝功能衰竭患者85例,健康志愿者10名为对照组.实时定量反转录PCR检测肝功能衰竭患者治疗前及治疗后1、2、3和4周PBMC hTERT mRNA的表达水平,根据随访3个月时的生存和死亡情况,动态分析患者PBMC hTERT mRNA的变化,受试者工作特征曲线下面积(AUC)分析PBMChTERT mRNA对肝功能衰竭预后的评估价值.均数的比较用独立样本t检验,计数资料的比较用x2检验,中位数的比较用Mann-Whitney U检验,患者临床因素对预后的影响用Logistic回归分析.结果 85例肝功能衰竭患者中具有完整研究资料的76例被纳入最终分析,其中生存52例,死亡24例.生存组PBMC hTERT mRNA的相对表达量随治疗时间的延长而增加,生存组在治疗后2、3和4周时均高于死亡组,差异均有统计学意义(U值分别为299.0、16.0和17.5,均P＜0.01).治疗后2、3和4周,患者PBMC hTERT mRNA的AUC分别为0.760、0.987和0.986(95％CI分别为0.652～0.869、0.965～1.009和0.958～1.014).且从治疗后2周开始,患者PBMC hTERT mRNA表达即对生存具有显著评估价值(P＜0.01).慢加急性肝功能衰竭患者PBMC hTERT mRNA表达水平在治疗后各观察点上均显著高于慢性肝功能衰竭患者(U值分别为414.0、436.5、377.0和385.0,均P＜0.05).慢加急性肝功能衰竭患者治疗后2、3和4周时生存组PBMC hTERT mRNA相对表达量均高于死亡组,差异均有统计学意义(U值分别为56.0、6.0和4.5,均P＜0.05);慢性肝功能衰竭患者治疗后2、3和4周时生存组PBMC hTERT mRNA相对表达量亦高于死亡组,差异均有统计学意义(U值分别为31.0、0和0,均P＜0.01).结论 肝功能衰竭的临床类型及预后与患者PBMC hTERT mRNA的表达密切相关,动态观察其水平的变化有助于评估肝功能衰竭的预后.
目的 探討肝功能衰竭患者在治療過程中PBMC耑粒酶反轉錄酶(hTERT) mRNA錶達的動態變化及其對預後的評估價值.方法 囌州市第五人民醫院肝病科2010年11月至2012年12月間收治的肝功能衰竭患者85例,健康誌願者10名為對照組.實時定量反轉錄PCR檢測肝功能衰竭患者治療前及治療後1、2、3和4週PBMC hTERT mRNA的錶達水平,根據隨訪3箇月時的生存和死亡情況,動態分析患者PBMC hTERT mRNA的變化,受試者工作特徵麯線下麵積(AUC)分析PBMChTERT mRNA對肝功能衰竭預後的評估價值.均數的比較用獨立樣本t檢驗,計數資料的比較用x2檢驗,中位數的比較用Mann-Whitney U檢驗,患者臨床因素對預後的影響用Logistic迴歸分析.結果 85例肝功能衰竭患者中具有完整研究資料的76例被納入最終分析,其中生存52例,死亡24例.生存組PBMC hTERT mRNA的相對錶達量隨治療時間的延長而增加,生存組在治療後2、3和4週時均高于死亡組,差異均有統計學意義(U值分彆為299.0、16.0和17.5,均P＜0.01).治療後2、3和4週,患者PBMC hTERT mRNA的AUC分彆為0.760、0.987和0.986(95％CI分彆為0.652～0.869、0.965～1.009和0.958～1.014).且從治療後2週開始,患者PBMC hTERT mRNA錶達即對生存具有顯著評估價值(P＜0.01).慢加急性肝功能衰竭患者PBMC hTERT mRNA錶達水平在治療後各觀察點上均顯著高于慢性肝功能衰竭患者(U值分彆為414.0、436.5、377.0和385.0,均P＜0.05).慢加急性肝功能衰竭患者治療後2、3和4週時生存組PBMC hTERT mRNA相對錶達量均高于死亡組,差異均有統計學意義(U值分彆為56.0、6.0和4.5,均P＜0.05);慢性肝功能衰竭患者治療後2、3和4週時生存組PBMC hTERT mRNA相對錶達量亦高于死亡組,差異均有統計學意義(U值分彆為31.0、0和0,均P＜0.01).結論 肝功能衰竭的臨床類型及預後與患者PBMC hTERT mRNA的錶達密切相關,動態觀察其水平的變化有助于評估肝功能衰竭的預後.
목적 탐토간공능쇠갈환자재치료과정중PBMC단립매반전록매(hTERT) mRNA표체적동태변화급기대예후적평고개치.방법 소주시제오인민의원간병과2010년11월지2012년12월간수치적간공능쇠갈환자85례,건강지원자10명위대조조.실시정량반전록PCR검측간공능쇠갈환자치료전급치료후1、2、3화4주PBMC hTERT mRNA적표체수평,근거수방3개월시적생존화사망정황,동태분석환자PBMC hTERT mRNA적변화,수시자공작특정곡선하면적(AUC)분석PBMChTERT mRNA대간공능쇠갈예후적평고개치.균수적비교용독립양본t검험,계수자료적비교용x2검험,중위수적비교용Mann-Whitney U검험,환자림상인소대예후적영향용Logistic회귀분석.결과 85례간공능쇠갈환자중구유완정연구자료적76례피납입최종분석,기중생존52례,사망24례.생존조PBMC hTERT mRNA적상대표체량수치료시간적연장이증가,생존조재치료후2、3화4주시균고우사망조,차이균유통계학의의(U치분별위299.0、16.0화17.5,균P＜0.01).치료후2、3화4주,환자PBMC hTERT mRNA적AUC분별위0.760、0.987화0.986(95％CI분별위0.652～0.869、0.965～1.009화0.958～1.014).차종치료후2주개시,환자PBMC hTERT mRNA표체즉대생존구유현저평고개치(P＜0.01).만가급성간공능쇠갈환자PBMC hTERT mRNA표체수평재치료후각관찰점상균현저고우만성간공능쇠갈환자(U치분별위414.0、436.5、377.0화385.0,균P＜0.05).만가급성간공능쇠갈환자치료후2、3화4주시생존조PBMC hTERT mRNA상대표체량균고우사망조,차이균유통계학의의(U치분별위56.0、6.0화4.5,균P＜0.05);만성간공능쇠갈환자치료후2、3화4주시생존조PBMC hTERT mRNA상대표체량역고우사망조,차이균유통계학의의(U치분별위31.0、0화0,균P＜0.01).결론 간공능쇠갈적림상류형급예후여환자PBMC hTERT mRNA적표체밀절상관,동태관찰기수평적변화유조우평고간공능쇠갈적예후.
Objective To investigate the dynamic change and its prognostic value of human telomerase reverse transcriptase (hTERT) mRNA expression in peripheral blood mononuclear cells (PBMC) during treatment of patients with liver failure.Methods Eighty-five patients with liver failure,who were hospitalized in Department of Hepatology,the Fifth People's Hospital of Suzhou,between November 2010 and December 2012,were enrolled,and ten healthy volunteers were enrolled as control.The levels of hTERT mRNA expressed by PBMC were detected by relative quantitative real-time polymerase chain reaction (RT-PCR) assay using the samples taken before treatment and at week 1,2,3 and 4 after treatment.The patients were divided into survival and non-survival groups according to the 3-month mortality after treatment.The dynamic variations of PBMC hTERT mRNA at different time points were analyzed,and their prognostic values were assessed by the area under the receiver operating characteristic curve (AUC).The means were analyzed by independent-samples t test,the rates by Pearson chi-square test,and the medians by nonparametric Mann-Whitney U test.Logistic regression was used to analyze the clinical factors on prognosis.Results Seventy-six patients with complete data among 85 patients were included in the final analysis.Of them,52 survived and 24 died.During the observation,the levels of PBMC hTERT mRNA increased with treatment duration in survival group,but those were persistently lower in non-survival group.The median levels in survival group were all significantly higher than those in non-survival group after 2,3 and 4 weeks of treatment (U value was 299.0,16.0 and 17.5,respectively; all P＜0.01),and the AUC were 0.760,0.987 and 0.986,respectively (95％ confidence intervals were 0.652-0.869,0.965-1.009 and 0.958-1.014,respectively).The expression levels of hTERT mRNA from week 2 of treatment showed significantly prognostic value (P＜ 0.01).Further analyses showed that the median level in patients with acute-on-chronic liver failure (ACLF) was remarkably higher than that in patients with chronic liver failure (CLF) at each studying time-point (U values were 414.0,436.5,377.0 and 385.0,respectively; all P＜0.05).The median levels in survival subgroup of ACLF patients were all markedly higher than that in non-survival subgroup after 2,3 and 4 weeks of treatment (U values were 56.0,6.0 and 4.5,respectively; all P＜0.05).Similarly,the levels were also all significantly higher in survival subgroup of CLF patients compared with those in non-survival subgroup after 2,3 and 4 weeks of treatment (U values were 31.0,0 and 0,respectively; all P＜0.01).Conclusions The clinical types and prognosis of liver failure are closely associated with the expression of PBMC hTERT mRNA,and its dynamic change might predict the prognosis of liver failure.
