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目的探讨乙型肝炎病毒(HBV)慢加急肝衰竭(ACLF)患者血中mRNA表达及意义。方法选取20例HBV所致ACLF患者作为肝衰竭组,20例健康体检者作为对照组,分析比较两组临床相关指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ谷氨酰转移酶(γ-GT)、凝血酶原活动度(PTA)、总胆红素(TBIL)、肌酐(Cr)、白细胞计数(WBC)],并分析HBV-ACLF患者三种微小RNA(mRNA)和临床指标[ALT、AST、白蛋白(ALB)、乙肝病毒的脱氧核糖核酸(HBV-DNA)、生存时间、PTA、凝血酶原时间的国际标准化比值(INR)、血小板(PLT)、TBIL、直接胆红素(DBIL)、乙肝核心抗体(HBc Ab)]的关系。结果肝衰竭组患者的ALT、AST、PTA、TBIL、Cr、WBC分别为(156.41±214.08)U/L、(232.59±314.12)U/L、(21.46±8.97)%、(324.60±164.76)μmol/L、(125.61±101.20)μmol/L、(8.12±5.29)×109/L,与对照组的(26.67±30.02)U/L、(24.22±7.60)U/L、(114.00±11.31)%、(12.83±3.25)μmol/L、(61.11±12.84)μmol/L、(5.14±1.74)×109/L比较,差异均具有统计学意义(P<0.05)。HBV-ACLF患者mRNA 150-5P与ALT、AST、PLT、TBIL、DBIL中度相关,与生存时间高度相关;mRNA 146a-5P与ALT高度相关,与AST、PTA、PLT、TBIL中度相关;mRNA 29a-3P与生存时间、PLT、TBIL中度相关。结论肝病病情越重,mRNA 146a-5P和mRNA 150-5P水平越低,mRNA 146a-5P和mRNA 150-5P对HBV-ACLF患者的预后评估有着重要意义,可以作为肝衰竭新的预后判断指标。
Objective To investigate the mRNA expression of blood in patients with chronic hepatitis B and acute hepatic failure (ACLF) and its significance. Methods Twenty patients with ACLF induced by HBV were selected as the liver failure group and 20 healthy subjects as the control group. The clinical indexes (ALT, AST, γ-glutamyl transferase (γ-GT, PTA, TBIL, Cr, WBC) were measured and the expression of three microRNAs (mRNA) and clinical Indicators [ALT, AST, albumin (ALB), hepatitis B virus DNA (HBV-DNA), survival time, PTA, International Normalized Ratio of prothrombin time (INR), platelet (PLT), TBIL, (DBIL), hepatitis B core antibody (HBc Ab)]. Results The levels of ALT, AST, PTA, TBIL, Cr and WBC were (156.41 ± 214.08) U / L, (232.59 ± 314.12) U / L and (21.46 ± 8.97)%, (324.60 ± 164.76) μmol / (125.61 ± 10.11.20) μmol / L, (8.12 ± 5.29) × 109 / L and (26.67 ± 30.02) U / L, (24.22 ± 7.60) U / L and (114.00 ± 11.31)% , (12.83 ± 3.25) μmol / L, (61.11 ± 12.84) μmol / L and (5.14 ± 1.74) × 109 / L, respectively) The mRNA 150-5P in HBV-ACLF patients was moderately correlated with ALT, AST, PLT, TBIL and DBIL, and was highly correlated with survival time. MRNA 146a-5P was highly correlated with ALT and moderately correlated with AST, PTA, PLT and TBIL. 29a-3P and survival time, PLT, TBIL moderate correlation. Conclusion The more severe the liver disease is, the lower the level of mRNA 146a-5P and mRNA 150-5P. The mRNA 146a-5P and mRNA 150-5P are important prognostic factors in patients with HBV-ACLF and can be used as a new prognostic indicator of liver failure.