目的外部验证诱因-炎症-器官衰竭模型(IFIO模型)在乙肝相关慢加急性肝衰竭(HBV-ACLF)28天预后预测中的适用性;若不适用,则再校准并构建适用于本队列的模型。方法回顾性纳入2015年09月至2024年09月安徽医科大学第二附属医院住院HBV-ACLF...目的外部验证诱因-炎症-器官衰竭模型(IFIO模型)在乙肝相关慢加急性肝衰竭(HBV-ACLF)28天预后预测中的适用性;若不适用,则再校准并构建适用于本队列的模型。方法回顾性纳入2015年09月至2024年09月安徽医科大学第二附属医院住院HBV-ACLF患者312例,按28天结局分生存(n=165)与死亡(n=147)。收集入院24h内临床与实验室资料,计算MELD、iMELD、MELD-Na、Child-Pugh、CLIF-CAD、CLIF-ACLF、CLIF-SOFA、CLIF-OF评分。以AUC和校准曲线外部验证IFIO,在预设候选变量基础上行多因素Logistic回归再校准,采用10折交叉验证评估泛化,并与上述评分比较区分度。结果:IFI0外部验证判别力一般(AUC=0.71),校准欠佳(Brier=0.41、斜率=0.23、Spiegelhalter’s Z P<0.001)。再校准后的最佳模型为Logit(P)=Ln(P/(1-P))=-8.883+1.147*(细菌感染)+2.607*Ln(INR)+0.536*Ln(NLR)+0.900*LN(TBil)+0.357*(乙肝发作伴高病毒载量)+0.085*(乙肝发作伴病毒再激活),其性能为AUC=0.81、Brier=0.17、斜率=1.02、Spiegelhalters Z P=0.90,区分度优于IFI0及MELD系列。10折交叉验证AUC=0.80、Brier=0.18、斜率=0.97、Spiegelhalter’s Z P=0.34。结论基于IFIO模型再校准后构建的模型有更实用的预测价值。展开更多
AIM： To investigate whether the function of hepatocytes co-cultured with bone marrow mesenchymal stem cells （MSCs） could be maintained in serum from acute-on- chronic liver failure （ACLF） patients.METHODS： Hepat...AIM： To investigate whether the function of hepatocytes co-cultured with bone marrow mesenchymal stem cells （MSCs） could be maintained in serum from acute-on- chronic liver failure （ACLF） patients.METHODS： Hepatocyte supportive functions and cy- totoxicity of sera from 18 patients with viral hepatitis B-induced ACLF and 18 healthy volunteers were evalu- ated for porcine hepatocytes co-cultured with MSCs and hepatocyte mono-layered culture, respectively. Chemo- kine profile was also examined for the normal serum and liver failure serum.RESULTS： Hepatocyte growth factor （HGF） and Tumor necrosis factor; tumor necrosis factor （TNF）-a were re- markably elevated in response to ACLF while epidermal growth factor （EGF） and VEGF levels were significantly decreased. Liver failure serum samples induced a higher detachment rate, lower viability and decreased liver sup- port functions in the homo-hepatocyte culture. Hepato-cytes co-cultured with MSCs could tolerate the cytotoxic- ity of the serum from ACLF patients and had similar liver support functions compared with the hepatocytes cul- tured with healthy human serum in vitro. In addition, co- cultured hepatocytes maintained a proliferative capability despite of the insult from liver failure serum.CONCLUSION： ACLF serum does not impair the cell morphology, viability, proliferation and overall metabolic capacities of hepatocyte co-cultured with MSCs in vitro.展开更多
文摘目的外部验证诱因-炎症-器官衰竭模型(IFIO模型)在乙肝相关慢加急性肝衰竭(HBV-ACLF)28天预后预测中的适用性;若不适用,则再校准并构建适用于本队列的模型。方法回顾性纳入2015年09月至2024年09月安徽医科大学第二附属医院住院HBV-ACLF患者312例,按28天结局分生存(n=165)与死亡(n=147)。收集入院24h内临床与实验室资料,计算MELD、iMELD、MELD-Na、Child-Pugh、CLIF-CAD、CLIF-ACLF、CLIF-SOFA、CLIF-OF评分。以AUC和校准曲线外部验证IFIO,在预设候选变量基础上行多因素Logistic回归再校准,采用10折交叉验证评估泛化,并与上述评分比较区分度。结果:IFI0外部验证判别力一般(AUC=0.71),校准欠佳(Brier=0.41、斜率=0.23、Spiegelhalter’s Z P<0.001)。再校准后的最佳模型为Logit(P)=Ln(P/(1-P))=-8.883+1.147*(细菌感染)+2.607*Ln(INR)+0.536*Ln(NLR)+0.900*LN(TBil)+0.357*(乙肝发作伴高病毒载量)+0.085*(乙肝发作伴病毒再激活),其性能为AUC=0.81、Brier=0.17、斜率=1.02、Spiegelhalters Z P=0.90,区分度优于IFI0及MELD系列。10折交叉验证AUC=0.80、Brier=0.18、斜率=0.97、Spiegelhalter’s Z P=0.34。结论基于IFIO模型再校准后构建的模型有更实用的预测价值。
基金Supported by the National Natural Science Foundation of China,No.30772129Jiangsu Provincial Key Medical Center for Hepatobiliary Disease,No.ZX200605
文摘AIM： To investigate whether the function of hepatocytes co-cultured with bone marrow mesenchymal stem cells （MSCs） could be maintained in serum from acute-on- chronic liver failure （ACLF） patients.METHODS： Hepatocyte supportive functions and cy- totoxicity of sera from 18 patients with viral hepatitis B-induced ACLF and 18 healthy volunteers were evalu- ated for porcine hepatocytes co-cultured with MSCs and hepatocyte mono-layered culture, respectively. Chemo- kine profile was also examined for the normal serum and liver failure serum.RESULTS： Hepatocyte growth factor （HGF） and Tumor necrosis factor; tumor necrosis factor （TNF）-a were re- markably elevated in response to ACLF while epidermal growth factor （EGF） and VEGF levels were significantly decreased. Liver failure serum samples induced a higher detachment rate, lower viability and decreased liver sup- port functions in the homo-hepatocyte culture. Hepato-cytes co-cultured with MSCs could tolerate the cytotoxic- ity of the serum from ACLF patients and had similar liver support functions compared with the hepatocytes cul- tured with healthy human serum in vitro. In addition, co- cultured hepatocytes maintained a proliferative capability despite of the insult from liver failure serum.CONCLUSION： ACLF serum does not impair the cell morphology, viability, proliferation and overall metabolic capacities of hepatocyte co-cultured with MSCs in vitro.
