| Objective:The purpose of this study is to explore the significance of Triggering Receptor Expressed on Myeloid cells-2(TREM-2)in predicting the prognosis of patients with HBV-related acute-on-chronic liver failure,and to provide a new reference index for the prognosis of patients with HBV-related acute-on-chronic liver failure.Methods:In this study,the research subjects were divided into an experimental group and a control group.The experimental group(patients with HBV-related acute-on-chronic liver failure): between January 01,2019 and December 31,2019,inpatients in the Department of Infection,the First Affiliated Hospital of Nanchang University,diagnosed as HBV-related acute-on-chronic liver failure and meet the inclusion criteria(inclusion criteria: screening according to liver failure diagnosis and treatment guidelines(2018 version),and exclude serious heart,brain,kidney,lung and blood system and other important organ diseases,excluding A and C,D,E and other hepatitis virus infections,with other obvious infections and alcoholic liver disease,drug-induced liver disease,autoimmune liver disease and primary liver cancer patients),a total of 50 patients,including 27 males and 23 females.The experimental group was further subdivided into two groups,which were divided into survival group and death group according to the actual prognosis of patients with HBV-related acute-on-chronic liver failure at discharge(automatic discharge and death are regarded as the death group,and all enrolled patients spent more than 28 days in hospital),survival group: a total of 25 patients,including 15 males and 10 females.Death group: a total of 25 patients,including 12 males and 13 females.Control group: A total of 25 healthy people,including 14 males and 11 females,were selected from the physical examination of the first Affiliated Hospital of Nanchang University during the same period.People of similar age to the experimental group were selected as far as possible,and obvious infections,malignant tumors and serious cardiovascular and cerebrovascular diseases were excluded.Under the condition of fasting at 6 o'clock in the morning,heparin sodium anticoagulant tube was used to draw peripheral venous blood for 4 ml in the experimental group and the control group.After the blood was collected,the upper plasma and lower blood cells were separated by centrifugation,and the upper plasma was taken to detect the concentration of TREM-2,IL-6 and IL-8 in the plasma.Peripheral blood mononuclear cell(PBMC),was extracted from the lower blood cells to detect the expression of TREM-2 mRNA in PBMC.The healthy control group took only one blood sample,while the patients with HBV-related acute-on-chronic liver failure took 5 blood samples on the day of admission(1 day)and 7 days(7 days),14days(14 days),21 days(21 days)and 28 days(28 days)after the start of treatment.At the same time,the relevant clinical indexes of patients with HBV-related acute-on-chronic liver failure were monitored at admission and 28 days after treatment,including liver function ALT,AST,TBIL and coagulation function INR.Results:1.The mRNA expression of TREM-2 in peripheral blood mononuclear cells of patients with HBV-related acute-on-chronic liver failure increased gradually at each time point in the survival group,and was significantly higher than that in the control group on the 28 th day(p=0.000).However,it showed a gradual weakening trend at each time point in the death group,and was significantly lower than that in the control group on the 28 th day(p= 0.000).2.The content of TREM-2 in plasma of patients with HBV-related acute-on-chronic liver failure increased gradually at each time point in the survival group,and the levels at 1 day after admission,7 days,14 days,21 days and 28 days after treatment were 1.49 ±0.85,1.62 ±0.58,1.95 ±0.69,2.33 ±0.71,2.00 ±0.67(ng/ml),respectively.However,the expression of TREM-2 in the dead group decreased gradually at each time point,and the levels at 1 day after admission,7 days,14 days,21 days and 28 days after treatment were 1.40 ±0.73,1.59 ±0.79,1.56 ±0.80,1.05±0.49,0.81 ±0.21(ng/ml),respectively.The level of TREM-2 in plasma of healthycontrol group was 1.25 ±0.35(ng/ml).3.The concentrations of IL-6 and IL-8 in the plasma of patients with HBV-related acute-on-chronic liver failure decreased gradually at each time point in the survival group.The levels were 46.70 ±26.31,33.98 ±20.28,19.07 ±10.24,14.76±7.84,9.12 ±7.65 and 108.29 ±47.07,93.85 ±26.53,79.27 ±34.63,56.72 ±18.30,37.81±13.88(pg/ml)on the 1st day after admission,7 days,14 days,21 days and 28 days after treatment,respectively.On the other hand,the concentration of its expression in the death group fluctuated in a higher range,and the levels on the 1st day after admission,7 days,14 days,21 days and 28 days after treatment were 41.94±24.19,36.99 ±19.78,34.30 ±20.62,34.14 ±14.52,36.64 ±23.61;104.65 ±50.16,112.98±45.03,118.43 ±45.00,111.67 ±40.44,109.55 ±27.54(pg/ml),respectively.4.The results of bivariate correlation analysis showed that the content of TREM-2 in peripheral blood plasma was negatively correlated with the levels of pro-inflammatory cytokines IL-6 and IL-8(r =-0.224,p = 0.025;r =-0.223,p =0.026).5.ROC curve analysis showed that the area under the curve of TREM-2 mRNA level in peripheral blood mononuclear cells at each time point to judge the prognosis of HBV-related acute-on-chronic liver failure patients was 1d = 0.667,7d = 0.757,14 d = 0.979,21 d = 0.986,28 d = 0.993,respectively.The area under the ROC curve of the TREM-2 content in plasma at each time point was 1d=0.522,7d=0.571,14d=0.658,21d=0.927,28d=0.994,respectively.Conclusion:The expression of TREM-2 mRNA in peripheral blood mononuclear cells and the content of TREM-2 in plasma show a significant correlation with the prognosis of patients with HBV-related acute-on-chronic liver failure.It may inhibit the inflammatory response of liver by regulating the secretion of pro-inflammatory cytokines IL-6 and IL-8.Dynamic monitoring of the expression of TREM-2 in peripheral blood is helpful to judge the prognosis of patients with HBV-related acute-on-chronic liver failure. |
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