血清肠型脂肪酸结合蛋白 (I-FABP) 在慢加急性肝衰竭 发生发展中的预测价值.

Objective To investigate the value of intestinal fatty acid binding protein (I-FABP) in predicting the development and progression of acute-on-chronic liver failure (ACLF). Methods A retrospective analysis was performed for the clinical data of 168 patients with decompensated liver cirrhosis who were admitted to The Affiliated Hospital of Yanbian University from September 2020 to March 2023. The conditions of the patients with ACLF on admission were observed, and the patients were followed up for 6 months to identify new-onset ACLF cases. ELISA was used to measure the serum level of I-FABP on admission. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H rank sum test was used for comparison between multiple groups; the chi-square test was used for comparison of categorical data between groups; the Jonckheere-Terpstra test was used for trend analysis. The Spearman correlation analysis was used to investigate the correlation between two variables, and the multivariate Cox regression analysis was used to investigate the influencing factors for new-onset ACLF during follow-up. The Kaplan-Meier curve was used to analyze the onset of ACLF in different groups, and the log-rank test was used for the analysis of such differences. The receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were used to investigate the performance of I-FABP in predicting the development and progression of ACLF. Results Among the 168 patients enrolled in this study, there were 43 patients with ACLF and 125 patients without ACLF, among whom 19 developed ACLF during follow-up. The patients with ACLF on admission had a significantly higher level of I-FABP than those without ACLF (Z= 4.359, P<0.001). The patients with new-onset ACLF had a significantly higher level of I-FABP than those without new-onset ACLF (Z= 3.414, P<0.001). The level of I-FABP increased with the increase in ACLF severity grade (H=17.385, P<0.001, Ptrend<0.001). The multivariate Cox regression analysis showed that I-FABP was independently associated with new-onset ACLF during follow-up (hazard ratio=2.138, 95% confidence interval [CI]: 1.297—3.525, P=0.003), and the tertile of I-FABP showed a good discriminatory ability (χ² =12.16, P<0.001). The ROC curve showed that I-FABP had a good performance in predicting the development and progression of ACLF, with an area under the ROC curve of 0.854 (95%CI: 0.791—0.903) and 0.747 (95%CI: 0.661—0.820), respectively, and an optimal cut-off value of 2.07 µg/L and 1.86 µg/L, respectively. Conclusion I-FABP can be used as a biomarker to predict the development and progression of ACLF, and it may help to identify high-risk patients and improve clinical management. [ABSTRACT FROM AUTHOR]