Serum heat shock protein 27 levels in patients with hepatocellular carcinoma

Levels of serum heat shock protein 27 (sHsp27) have been studied in numerous cancer types, but their potential relevance in patients with hepatocellular carcinoma (HCC) is undetermined. Our aim was to compare sHsp27 levels in patients with HCC and HCC-free controls. Specifically, we recruited 71 patients with HCC (80 % with early tumour), 80 patients with chronic liver disease (59 with liver cirrhosis and 21 with chronic active hepatitis) and 42 healthy subjects. sHsp27 was measured by immunoenzymatic assay. Results showed that sHsp27 levels were significantly (p < 0.001) higher in patients with HCC than in the other groups, particularly in those with hepatitis C virus (HCV)-related disease. In HCC patients, sHsp27 levels were not associated with prognostic risk factors, such as size/multiplicity of nodules and stage. In logistic regression analysis, performed in patients with liver disease, log-sHsp27 was associated with a significant age-adjusted 2.5-fold increased odds ratio of HCC and with a significant 4.4-fold higher odds ratio of HCC in the subgroup with HCV-related liver disease. In receiver operating characteristic curve analysis, sensitivity and specificity of the best sHsp27 cut-off value (456.5 pg/ml) for differentiating patients with HCC from those with HCC-free chronic liver disease were 70 and 73 %, respectively. In conclusion, sHsp27 levels are enhanced in patients with HCC and may represent a candidate biomarker of HCC.     

Changes in anti-heat shock protein 27 antibody and C-reactive protein levels following cardiac surgery and their association with cardiac function in patients with cardiovascular disease

The relationship between serum anti-heat shock protein (Hsp)27 antibody and high sensitive C-reactive protein (hs-CRP) levels and indices of cardiac function were investigated in patients undergoing coronary artery bypass grafting (CABG) or heart valve replacement. The changes in anti-Hsp27 antibody titers and hs-CRP levels were compared among patients undergoing off-pump and on-pump CABG or valvular heart replacement. Fifty-three patients underwent off-pump, on-pump CABG, and heart valvular replacement in each group. Serum anti-Hsp27 titers and hs-CRP values were measured 24 h before and after the operation and at discharge. Echocardiography was performed before surgery and before discharge. The results were compared with values from 83 healthy controls. hs-CRP levels increased and anti-Hsp27 antibody decreased following surgery (P < 0.001 and P < 0.05, respectively), although these changes were independent of operative procedure (P = 0.361 and P = 0.120, respectively). Anti-Hsp27 antibody levels were higher at the time of discharge (P = 0.016). Only in coronary patients were anti-Hsp27 antibody levels negatively associated with E/E′ (r = −0.268, P = 0.022), a marker of pulmonary capillary wedge pressure. In conclusions, anti-Hsp27 antibody levels are associated with indices of cardiac function in coronary patients. Cardiopulmonary bypass had no significant effect on the induction of changes in anti-Hsp27 levels. Moreover, anti-Hsp27 antibody levels fell in all groups postoperatively; this may be due to the formation of immune complexes of antigen–antibody, and antibody levels were higher at the time of discharge.

Electronic supplementary material

The online version of this article (doi:10.1007/s12192-012-0358-y) contains supplementary material, which is available to authorized users.     

Serum levels of heat shock protein 27 in patients with acute ischemic stroke

Expression of intracellular heat shock protein 27 (Hsp27) rises in the brain of animal models of cerebral ischemia and stroke. Hsp27 is also released into the circulation and the aim of the present study was to investigated if serum Hsp27 (sHsp27) levels are altered in patients with acute ischemic stroke. sHsp27 was measured in 15 patients with acute ischemic stroke and in 14 control subjects comparable for age, sex, and cardiovascular risk factors. In patients, measurements were performed at admission and 1, 2, and 30 days thereafter. At admission, mean sHsp27 values were threefold higher in patients than in controls. In patients, sHsp27 values dropped after 24 h, rose again at 48 h, and markedly declined at 30 days, indicating the presence of a temporal trend of sHsp27 values following acute ischemic stroke.     

Serum antibody titers against heat shock protein 27 are associated with the severity of coronary artery disease

Antibody titers to several heat shock proteins (anti-Hsps) have been reported to be associated with the severity and progression of cardiovascular disease. However, there are little data regarding anti-Hsp27 titers in patients with coronary artery disease (CAD). A total of 400 patients with suspected CAD were recruited. Based on the results of coronary angiography, these patients were classified into CAD⁺ (n = 300) and CAD⁻ (n = 100) groups defined as patients with ≥50% and <50% stenosis of any major coronary artery, respectively. Eighty-three healthy subjects were also recruited as the control group. Serum anti-Hsp27 IgG titers were measured using an in-house enzyme-linked immunosorbent assay. CAD⁺ patients had significantly higher anti-Hsp27 titers compared with both CAD⁻ and control groups. Anti-Hsp27 titers were also higher in the CAD⁻ group compared with the control group. With regard to the number of affected vessels in the CAD⁺ group, patients with three-vessel disease had higher anti-Hsp27 titers compared with both two-vessel disease (2VD) and one-vessel disease (1VD) subgroups. However, there was no significant difference between 1VD and 2VD subgroups. In multiple linear regression analysis, the number of narrowed vessels and smoking were significant independent determinants of serum anti-Hsp27 titers. The present findings indicate that serum anti-Hsp27 titers may be associated with the presence and severity of coronary artery disease.     

Attenuated phosphorylation of heat shock protein 27 correlates with tumor progression in patients with hepatocellular carcinoma

Heat shock protein 27 (HSP27) is expressed at high levels in human hepatocellular carcinoma (HCC). We examined correlations of total HSP27 and serine phosphorylated (Ser-15, Ser-78, and Ser-82) HSP27 levels in HCC tissues with clinical and pathologic characteristics in 48 resected HCC specimens. The levels of total and Ser-phosphorylated HSP27 were evaluated by Western blot analysis. Immunohistochemical analysis of HSP27 expression was also performed on some samples. Phosphorylation of HSP27 was detected in all 48 HCC tissues. Levels of phosphorylated HSP27 were correlated inversely with tumor size, microvascular invasion of HCC, and tumor stage by TNM classification. In contrast, only microvascular invasion showed an inverse correlation with total HSP27 levels. The decrease in phosphorylated HSP27 in progressed HCC was also observed by immunohistochemistry. Levels of phosphorylated HSP27 gradually decreased in parallel with HCC progression. Our findings suggest that phosphorylated HSP27 may have a suppressive role in progression of human HCC.     

Heat shock protein 70 and anti-heat shock protein 70 antibodies in patients with chronic glomerulonephritis

We evaluated the heat shock system 70 (HSP70) in patients with chronic glomerulonephritis (CGN). Seventy-six patients with CGN patients were included in our study. Ten patients with mild proteinuria (median 0.48 [0.16–0.78] g/24 h) and ten healthy subjects served as positive and negative controls, respectively. Urinary levels of HSP70, interleukin-10, and serum levels of anti-HSP70 were measured by ELISA. The immunohistochemical peroxidase method was used to study the expression of HSP70 and Foxp3+ in kidney biopsies. Treg^FoxP3+ cells in the interstitium were determined morphometrically. Median urinary HSP70 levels in patients with nephrotic syndrome (NS) [6.57 (4.49–8.33) pg/mg] and subnephrotic range proteinuria [5.7 (4.12–6.9) pg/mg] were higher (p?<?0.05) than in positive [3.7 (2.5–4.82) pg/mg] and negative [3.78 (2.89–4.84) pg/mg] controls. HSP70 expression index in tubular cells positively correlated with urinary HSP70 (Rs?=?0.948, р?<?0.05) and proteinuria (Rs?=?0.362, p?<?0.05). The number of Treg^Foxp3+ cells in the kidney interstitium and interleukin-10 excretion were lower in patients with NS. Anti-HSP70 antibody serum levels in patients with NS [21.1 (17.47–29.72) pg/ml] and subnephrotic range proteinuria [24.9 (18.86–30.92) pg/ml] were significantly higher than in positive [17.8 (12.95–23.03) pg/ml] and negative [18.9 (13.5–23.9) pg/ml] controls. In patients with CGN, increasing proteinuria was associated with higher HSP70 renal tissue and urinary levels. However, activation of HSP70 in patients with nephrotic syndrome did not lead to an increase in tissue levels of Treg^Foxp3+ cells or to the release of IL-10.     

Serum heat shock protein 47 levels in patients with drug-induced lung disease

Background

Heat shock protein (HSP) 47 is a collagen-specific molecular chaperone that is required for molecular maturation of various types of collagens. We recently reported that HSP47 serum levels were markedly higher in patients with acute exacerbations of idiopathic pulmonary fibrosis (IPF) when compared with patients with stable IPF, suggesting that serum HSP47 levels correlate with interstitial pneumonia activity. The aim of this study was to evaluate serum HSP47 levels in patients with drug-induced lung disease (DILD).

Methods

Findings from high-resolution computed tomographic chest scans of 47 patients with DILD were classified into one of four predominant patterns: organizing pneumonia (OP) (n = 4), nonspecific interstitial pneumonia (NSIP) (n = 24), hypersensitivity pneumonitis (HP) (n = 11), and diffuse alveolar damage (DAD) (n = 8). Serum levels of HSP47, Krebs von den Lungen-6 (KL-6), surfactant protein (SP)-A, and SP-D were measured in these patients.

Results

The PaO₂/fraction of inspired oxygen (FiO₂) (P/F) ratios were significantly lower and the alveolar-arterial difference of oxygen (A-a DO₂) was significantly higher in the DAD group than in the other groups. Patients with DAD had the worst outcomes among the different subgroups. Patients in the DAD group had significantly higher serum HSP47 levels than those in other groups. Receiver operating characteristic curves revealed that HSP47 was superior to KL-6, SP-A, and SP-D for discriminating between the DAD group and the other groups. The cut-off level for HSP47 that resulted in the highest diagnostic accuracy was 1711.5 pg/mL. The sensitivity, specificity, and diagnostic accuracy were 87.5%, 97.4%, and 95.7%, respectively. Serum levels of HSP47 in the group of patients requiring glucocorticoids were significantly higher than those in patients who experienced clinical improvement without glucocorticoid administration. Serum HSP47 levels also significantly correlated with various respiratory parameters.

Conclusion

This study demonstrated that serum HSP47 levels were elevated in patients with DILD with a DAD pattern who had the worst outcomes among the different subgroups, and that this was correlated with P/F ratio and A-a DO₂.     

心肌特异性高表达热休克蛋白27转基因鼠建立

目的 建立人热休克蛋白27（heat shock protein 27, Hsp27）基因在小鼠心肌特异性表达的转基因鼠模型。 方法 将人心肌Hsp27cDNA插入含有心肌特异性表达启动子αMHC的pBSⅡ-SK+载体中,限制性内切酶EcoRI酶切、纯化后,获得含有αMHC启动子－Hsp27cDNA－HGH polyA的线性DNA片段,以显微注射法将目的基因导入受精卵, PCR筛选基因型,Western Blot鉴定转移基因的表达和表达的组织特异性。结果和结论 共获得两个转基因系小鼠,均呈心肌组织特异性高表达。     

血清铁蛋白含量与HBV相关慢性肝病的临床相关性

目的 研究HBV相关慢性肝病患者血清铁蛋白（SF）含量及其与肝功能血清学指标的相关性,进一步探讨铁蛋白在诊断HBV相关慢性肝病中的价值。方法 选取2016年1~6月于安徽医科大学第二附属医院就诊的慢性乙型肝炎患者（CHB）27例、肝硬化代偿期患者（LC）17例、肝硬化失代偿期患者（DLC）30例及健康对照者30例。采用免疫比浊法分析患者SF含量,采用Spearman秩相关分析SF含量与血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、白蛋白（ALB）、前白蛋白（PALB）、总胆红素水平（TBIL）的相关性,运用受试者工作特征（ROC）曲线评价SF能否作为鉴别诊断LC与DLC的临床指标。结果 与对照组相比,CHB患者与LC患者的SF水平明显升高,DLC患者SF水平明显低于CHB患者。与LC患者相比,DLC患者SF水平明显降低。CHB患者与LC患者间SF水平差异无统计学意义。ROC曲线显示,采用SF诊断LC与DLC的曲线下面积为0.816,敏感性为56.67%,特异性为94.12%,界值为66.3。Spearman分析显示,CHB患者SF水平与ALT、AST、TBIL水平呈显著正相关,与ALB、PALB水平呈显著负相关;LC患者SF水平与ALT、AST、TBIL水平呈显著正相关;DLC患者SF水平与ALB、PALB、TBIL水平呈显著正相关。结论 SF水平与HBV相关慢性肝病的进展具有相关性,可作为临床鉴别诊断LC与DLC的血清学指标和判断HBV相关肝病损伤的潜在指标。     

热休克蛋白27在肿瘤中的研究进展

热休克蛋白27（HSP27）作为热应激蛋白表达于各种生理或是环境损伤之后,保护细胞生存,其具有多种功能包括：分子伴侣,抗凋亡,参与细胞运动等。近年来发现HSP27在多种肿瘤中过度表达,参与肿瘤的发生发展,分化,耐药以及转移等方面,因而抑制HSP27成为一种新的肿瘤治疗策略。本文就相关研究进展进行综述。     

热休克蛋白27 在肿瘤中的研究进展

热休克蛋白27(HSP27)作为热应激蛋白表达于各种生理或是环境损伤之后,保护细胞生存,其具有多种功能包括:分子伴侣,抗凋亡,参与细胞运动等。近年来发现HSP27在多种肿瘤中过度表达,参与肿瘤的发生发展,分化,耐药以及转移等方面,因而抑制HSP27成为一种新的肿瘤治疗策略。本文就相关研究进展进行综述。     

Characterization of proteins associated with heat shock protein hsp27 in the squamous cell carcinoma cell line A431.

Heat shock protein hsp27 is a molecular chaperone and identification of hsp27-binding proteins might help to elucidate its functional role in keratinocyte biology. In the present investigation we used a human epidermal cell carcinoma cell line (A431) transfected with hsp27 (A431/16) to study interference between hsp27 protein and other proteins. Immunoprecipitation experiments with anti-hsp27 antibody revealed a multicomponent complex when analysed by silver staining. By immunoblotting analysis we could demonstrate that hsp27 associates with actin, the mutant form of p53, hsp70 and hsp90. Immunofluorescence analysis showed a co-localization between hsp27 and p53, hsp70 and hsp90. To control for the specificity of the observed interactions, immuno-precipitations with antibodies to actin, p53, hsp70 and hsp90 respectively, were performed. All of the tested proteins demonstrated a coimmunoprecipitation with hsp27. We conclude that hsp27, like the other heat shock proteins, is part of a complex system of molecular chaperones in epidermal keratinocytes.     

CD27／CD27L 在肝癌患者血清中的含量及临床意义

目的:探讨原发性肝癌患者外周血中CD27和CD27L的含量及其临床意义。方法:采用ELISA法检测38例肝癌患者和40例健康查体者外周血中CD27及CD27L蛋白的含量,并分析两者与病理类型和临床分期的关系。结果:与健康查体组相比,肝癌患者外周血中CD27蛋白含量未检测到明显变化(t=1.760,P=0.082),但CD27L蛋白含量显著升高(t=39.982,P<0.001)。Spearman秩相关分析表明CD27和CD27L之间无显著相关性(rs=0.305,P=0.084)。CD27在不同病理类型和不同病理分期的肝癌患者血清中的含量无统计学差异(P>0.05);CD27L蛋白含量在III期和发生淋巴结转移的患者中显著升高(P<0.05)。结论:CD27/CD27L通路与肝癌的恶性进展和淋巴结转移有密切关系。     

Heat-shock protein 27: a potential biomarker for hepatocellular carcinoma identified by serum proteome analysis

Hepatocellular carcinoma (HCC) is the third leading cause of cancer mortality worldwide and ranks second in China. The prognosis of HCC remains dismal mainly because of its late diagnosis, especially in patients with coexisting chronic liver diseases. To identify serum biomarkers for HCC, sera from 20 healthy volunteers, 20 hepatitis B virus (HBV) infected patients and 20 HCC patients were selected for screening study and same number of sera into the same three groups were used for validation study. A strategy including sonication, albumin and immunoglobulin G (IgG) depletion and desalting was optimized for screening differentially expressed proteins of low abundance in serum. By 2-DE image analysis and MALDI-TOF-MS/MS identification, eight proteins including heat-shock protein 27 (HSP27), alpha-fetoprotein (AFP), alpha-1 antitrypsin, clusterin, caeruloplasmin, haptoglobin alpha2 chain, tranferrin and transthyretin were found significantly changed among the healthy, HBV and HCC groups. Further validation study by Western blot showed the detection of HSP27 in 90% HCC sera and two HBV sera, but in none of normal sera. Thus, 2-DE based serum proteome analysis can be useful in the screening of serum biomarkers for HCC and HSP27 could aid in the diagnosis of HCC though further validation is needed.     

Protein kinase C delta regulates the phosphorylation of heat shock protein 27 in human hepatocellular carcinoma

We have recently reported that attenuated phosphorylation of heat shock protein (HSP) 27 correlates with tumor progression in patients with hepatocellular carcinoma (HCC). In the present study, we investigated what kind of kinase regulates phosphorylation of HSP27 in human HCC-derived HuH7 cells. 12-O-tetradecanoylphorbol-13-acetate (TPA) and 1-oleoyl-2-acetylglycerol, direct activators of protein kinase C (PKC), markedly strengthened the phosphorylation of HSP27. Bisindorylmaleimide I, an inhibitor of PKC, suppressed the TPA-induced levels of HSP27 phosphorylation in addition to its basal levels. Knock down of PKCdelta suppressed HSP27 phosphorylation, as well as p38 mitogen-activated protein kinase (MAPK) phosphorylation. SB203580, an inhibitor of p38 MAPK, suppressed the TPA-induced HSP27 phosphorylation. Our results strongly suggest that activation of PKCdelta regulates the phosphorylation of HSP27 via p38 MAPK in human HCC.     

PROGRESS STUDY: Progression of chronic kidney disease in children and heat shock proteins

Various molecular and cellular processes are involved in renal fibrosis, such as oxidative stress, inflammation, endothelial cell injury, and apoptosis. Heat shock proteins (HSPs) are implicated in the progression of chronic kidney disease (CKD). Our aim was to evaluate changes in urine and serum HSP levels over time and their relationships with the clinical parameters of CKD in children. In total, 117 children with CKD and 56 healthy children were examined. The CKD group was followed up prospectively for 24 months. Serum and urine HSP27, HSP40, HSP47, HSP60, HSP70, HSP72, and HSP90 levels and serum anti-HSP60 and anti-HSP70 levels were measured by ELISA at baseline, 12 months, and 24 months. The urine levels of all HSPs and the serum levels of HSP40, HSP47, HSP60, HSP70, anti-HSP60, and anti-HSP70 were higher at baseline in the CKD group than in the control group. Over the months, serum HSP47 and HSP60 levels steadily decreased, whereas HSP90 and anti-HSP60 levels steadily increased. Urine HSP levels were elevated in children with CKD; however, with the exception of HSP90, they decreased over time. In conclusion, our study demonstrates that CKD progression is a complicated process that involves HSPs, but they do not predict CKD progression. The protective role of HSPs against CKD may weaken over time, and HSP90 may have a detrimental effect on the disease course.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12192-021-01239-9.     

高原地区慢性肝病肠道微生态结构的变化

目的分析高原地区慢性肝病患者肠道菌群物种多样性及菌群丰度结构变化,探讨肠道微生态失衡与慢性肝病的关联。方法收集高原地区90例慢性肝病(慢性乙型病毒性肝炎30例、乙肝后肝硬化30例、原发性肝癌30例)及25例健康人的粪便,利用高通量基因测序及生物信息学分析技术,探讨慢性肝病患者与健康人之间物种多样性以及不同分类水平上肠道菌群组成是否存在差异。结果慢性肝病患者肠道菌群多样性较健康人显著降低(Z=1.462,P=0.005),Beta多样性分析发现慢性肝病患者与健康人肠道菌群组成上差异存在统计学意义(r=0.122,P=0.020);对慢性肝病组与健康组进行组间肠道菌群差异性分析,发现在门水平上,拟杆菌门在慢性肝病组中富集(Z=1.065,P=0.043),慢性肝病组内比较发现拟杆菌门在慢性乙型病毒性肝炎、乙肝后肝硬化、原发性肝癌患者中的相对丰度呈逐渐减少的趋势,但差异无统计学意义(P>0.050);属水平上,粪杆菌属在慢性肝病组中富集(Z=1.092,P=0.032),而肠球菌属分布减少(Z=1.398,P=0.036),同时慢性肝病患者肠道菌群中一些潜在致病菌如链球菌属、韦荣球菌属较健康人富集,而双歧杆菌属、乳杆菌属等益生菌相对丰度较低,但差异无统计学意义。组内比较发现存在差异菌属链球菌属(H=6.026,P=0.049)、韦荣球菌属(H=10.317,P=0.005),对差异菌属进行两两比较发现相较原发性肝癌组,链球菌属在乙肝后肝硬化组中更加富集,差异有统计学意义(P<0.050),同时发现肝硬化及肝癌组中韦荣球菌属的相对丰度较慢性乙型病毒性肝炎组高,但差异无统计学意义(P>0.050)。相关性分析发现粪杆菌属与ALT、AST、ALP水平呈正相关(r=0.192、0.187、0.276,均P<0.050),韦荣球菌属与TB、ALP水平呈正相关(r=0.257、0.225,均P<0.050)。结论高原地区慢性肝病患者肠道微生物多样性显著降低,且慢性肝病患者与健康人肠道菌群组成上存在差异,在慢性肝病的进展中一些潜在致病菌的丰度逐渐增加,同时益生菌的相对丰度呈逐渐减少的趋势。     

质子泵抑制剂对慢性肝病患者肠道微生态的影响

目的探究质子泵抑制剂(PPIs)对慢性肝病患者肠道微生态的影响。方法选取郑州市第六人民医院2018年12月至2019年3月诊断及拟行PPIs治疗的慢性肝病患者31名,使用奥美拉唑进行治疗,20 mg/次,2次/d,疗程4周,检测治疗前后肠道菌群的构成。结果治疗前后患者肠道菌群构成差异显著:治疗后患者肠道菌群在Shannon指数(4.61±0.62 vs 5.01±0.83;t=2.889,P=0.005)、Simpson指数(0.89±0.09 vs 0.95±0.11;t=3.159,P=0.002)显著低于治疗前;治疗前患者肠道菌群中Coriobacteriaceae、Eggerthella、Ruminococcus、Anaerotruncus、Dorea、Turicibacter、Paraprevotella的相对丰度显著高于治疗后,治疗后肠道菌群中Veillonellaceae、Campylobacter、Haemophilus、Streptococcus、Streptococcaceae、Lactobacillus、Lactobacillaceae的相对丰度显著高于治疗前(均P<0.05)。结论PPIs可改变慢性肝病患者肠道菌群的构成。     

Serum levels of interleukin (IL)-27 in patients with ischemic heart disease

Objective

Cytokines, the key mediators of immune responses, play an important role in the pathogenesis of cardiovascular diseases. The aim of this study was to evaluate the serum levels of IL-27 in patients with ischemic heart disease (IHD) and also to clarify its association with traditional risk factors of the disease.

Methods

A total of 120 patients with IHD as having acute myocardial infarction (AMI; n = 60) or unstable angina (UA; n = 60) and 60 sex- and age-matched healthy subjects as a control group were enrolled in this cross-sectional, case-controlled study. Serum samples were collected from all participants (for AMI patients at 3–5 days after events and for UA at admission time) and tested for the levels of IL-27 by use of ELISA method.

Results

The mean serum levels of IL-27 in AMI group (38.00 ± 14.38 Pg/ml) and UA group (35.77 ± 18.93 Pg/ml) were significantly higher than those observed in the control group (24.91 ± 14.96 Pg/ml; P < 0.0001 and 0.001, respectively). The mean serum levels of IL-27 in IHD patients with or without a certain traditional risk factor including hypertension, dyslipidemia, diabetes smoking were significantly higher as compared to those in the control group.

Conclusions

These results showed that the higher serum levels of IL-27 were associated with IHD. The presence or absence of certain traditional risk factors of IHD did not influence the serum levels of cytokine.     

慢性乙肝肝硬化患者肝性脑病不同分级与肝脏储备功能的相关性

回顾性研究分析慢性乙肝肝硬化并发不同分级的肝性脑病（HE）患者的临床特点,探究影响HE患者预后的因素。

将380例HE患者根据临床症状进行分级,分为1～4级。分析各级HE患者的性别、年龄、实验室检查情况、终末期肝病模型（MELD）、谷草转氨酶与血小板计数比值（APRI）及白蛋白与总胆红素比值（ALBI）。采用Spearman相关性分析轻、重型HE的影响因素,并使用多因素Logistic回归法分析HE预后的影响因素,最后选用ROC曲线来评估各种独立变量对HE预后的预测价值。

1～4级HE患者组间性别、年龄差异均无统计学意义（均P＞0.05）,而血氨、MELD、APRI和ALB差异均有统计学差异（均P＜0.05）。轻、重型HE患者中性粒细胞计数和淋巴细胞计数的比值（NLR）、血氨、总胆红素（TBil）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、肿瘤坏死因子（TNF-α）、MELD、APRI及ALBI差异有统计学意义（均P＜0.05）。相关性分析显示,NLR、PLR、血氨、TBIL、ALT、AST及TNF-α是重型HE的独立影响因素。血氨及MELD评分与肝脏储备功能的相关性最高。NLR、血氨、TBil、TNF-α、高MELD评分及合并电解质紊乱均为HE预后的独立影响因素。ROC曲线分析显示,NLR的曲线下面积最大,其灵敏度最高、特异度也最大。

MELD、APRI和ALBI可用来评估不同分级HE患者的肝脏储备功能。在轻、重型HE中,血氨及MELD评分影响最大。在评估预后影响因素中,NLR水平可作为HE患者预后不良的危险因素。