Testosterone and Estradiol as Novel Prognostic Indicators for HBV-Related Acute-on-Chronic Liver Failure.
Testosterone and Estradiol as Novel Prognostic Indicators for HBV-Related Acute-on-Chronic Liver Failure.
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睾酮和雌二醇作为 HBV 相关慢性急性肝衰竭的新预后指标
DOI：
10.3389/fmed.2021.729030
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发表时间：
2021
影响因子：
3.9
通讯作者：
Deng G
中科院分区：
文献类型：
--
作者：
Sun S;Xu B;Tan W;Xiang X;Zhou Y;Dan Y;Guo Y;Tan Z;Deng G
背景：乙型肝炎病毒相关的慢加急性肝衰竭（HBV - ACLF）短期死亡率高，迫切需要一个简便且准确率高的预警系统。既往研究表明，性激素在乙型肝炎病毒相关肝病的进展中发挥着潜在作用。
目的：探讨睾酮和雌二醇对HBV - ACLF发生及预后的影响。
方法：纳入300例慢性乙型肝炎（CHB）患者的前瞻性队列，其中108例入院时即诊断为HBV - ACLF，20例在住院期间进展为HBV - ACLF。我们比较了不同ACLF背景、疾病严重程度及肝硬化情况患者的血清睾酮和雌二醇水平，并分析其对短期预后的预测能力。构建了一个包含睾酮的新型预后模型，并在HBV - ACLF组中进一步验证。
结果：HBV - ACLF组的基线雌二醇水平显著高于非ACLF组，而睾酮水平则低于非ACLF组。随着器官衰竭数量的增加，雌二醇水平升高，睾酮水平降低。睾酮对HBV - ACLF短期死亡率的预测具有较高准确性（受试者工作特征曲线下面积AUROC = 0.726），雌二醇在预测住院期间ACLF发生方面表现更佳（AUROC = 0.695）。包含睾酮的新型预后模型（TATIM模型）被证实对有或无肝硬化的HBV - ACLF队列均具有相当的预测效能。
结论：睾酮可作为HBV相关ACLF的短期预后指标，雌二醇有助于预测其发生。TATIM模型是一种新型的HBV相关ACLF预后模型，简便且无论是否存在肝硬化均具有良好的预测性能。
临床试验注册号：本研究基于一项前瞻性多中心队列的子队列（NCT02457637）。
Background: HBV-related acute-on-chronic liver failure (HBV-ACLF) has a high short-term mortality and urgently needs an early warning system with simplicity and high accuracy. Previous studies show that sex hormones play potential roles in the progression of HBV-related liver diseases. Aims: To explore the effect of testosterone and estradiol on the occurrence and prognosis of HBV-ACLF. Methods: A prospective cohort of 300 chronic hepatitis B (CHB) patients was enrolled among which 108 were diagnosed with HBV-ACLF at admission and 20 developed to HBV-ACLF during hospitalization. We compared the level of serum testosterone and estradiol of patients with varied ACLF background, disease severity and cirrhosis conditions and analyzed the predictive ability of short-term prognosis. A novel prognostic model involving testosterone was developed and further validated in the HBV-ACLF group. Results: The baseline estradiol level of HBV-ACLF group was significantly higher while testosterone was lower than that of non-ACLF group. The estradiol level increased while the testosterone level decreased as the number of organ failures increased. Testosterone had high accuracy in predicting the short-term mortality in HBV-ACLF (AUROC = 0.726) and estradiol did better in predicting the occurrence of ACLF during hospitalization (AUROC = 0.695). The novel prognostic model involving testosterone (TATIM model) was proved to have considerable prediction efficiency in HBV-ACLF cohort with or without cirrhosis. Conclusion: Testosterone could be utilized as short-term prognostic indicator for HBV-related ACLF and estradiol can help to predict its occurrence. TATIM model is a novel prognostic model for HBV-related ACLF with simplicity and good performance irrespectively of liver cirrhosis. Clinical Trial Registration Number: This study was based on a sub-cohort from the prospective multicenter cohort (NCT02457637).
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影响因子：
4.3
作者：
Kovats S
通讯作者：
Kovats S
影响因子：
64.5
作者：
Li Z;Tuteja G;Schug J;Kaestner KH
通讯作者：
Kaestner KH
影响因子：
25.7
作者：
Jalan, Rajiv;Saliba, Faouzi;Arroyo, Vicente
通讯作者：
Arroyo, Vicente
DOI：
10.1002/hep.28514
发表时间：
2016-07
期刊：
Hepatology (Baltimore, Md.)
影响因子：
--
作者：
Klair JS;Yang JD;Abdelmalek MF;Guy CD;Gill RM;Yates K;Unalp-Arida A;Lavine JE;Clark JM;Diehl AM;Suzuki A;Nonalcoholic Steatohepatitis Clinical Research Network
通讯作者：
Nonalcoholic Steatohepatitis Clinical Research Network
影响因子：
25.7
作者：
Okada, K;Ueshima, S;Matsuo, O
通讯作者：
Matsuo, O