血清TRAF6、FGF21表达与肝硬化合并上消化道出血患者病情程度及预后的关系OA

Objective To investigate the relationship between serum tumor necrosis factor receptor-associated factor 6(TRAF6)and fibroblast growth factor 21(FGF21)levels and disease severity and prognosis in patients with liver cirrhosis complicated by upper gastrointestinal bleeding(UGIB).Methods A total of 85 patients with liver cirrhosis and UGIB were prospectively enrolled as the UGIB group,with further subgrouping based on disease severity and prognosis.Additionally,85 healthy individuals who underwent physical examinations at our hospital during the same period were included as the normal control(NC)group.Spearman rank correlation analysis was used to evaluate the association between serum TRAF6 and FGF21 levels and disease severity.A multivariate logistic regression model was applied to identify factors affecting patient prognosis.ROC curves were used to assess the predictive performance of individual markers and their combination.The clini-cal utility of the combined model was further evaluated using decision curve analysis(DCA),and the clinical net benefit was assessed via the clinical impact curve(CIC).Results Serum TRAF6 and FGF21 levels were significantly higher in the UGIB group than in the NC group(t=11.557,14.069;both P<0.001),and showed an increasing trend with disease severity(F=18.291,21.998;both P<0.001).Serum TRAF6 and FGF21 levels were positively correlated with the severity of UGIB in pa-tients with liver cirrhosis(r=0.402,0.413;both P<0.001).In the poor prognosis subgroup,patients with Child-Pugh class C,severe disease,and rebleeding within 24 hours had significantly higher serum TRAF6 and FGF21 levels compared to those with good prognosis(χ2/t=8.136,7.360,4.413,7.610,7.661;all P<0.05).Disease severity and elevated serum TRAF6 and FGF21 levels were independent risk factors for poor prognosis[OR(95%CI)=2.634(1.246-5.569),2.749(1.313-5.756),2.347(1.239-4.446)].The AUCs of serum TRAF6,FGF21,and their combination for predicting poor prognosis were 0.863,0.852,and 0.944,respectively,with the combined model showing superior predictive value(Z=2.671,2.142;both P<0.001).DCA indicated that the combined model provided better clinical net benefit than individual markers within the threshold range of 0.09-0.89.The CIC curve showed that when the risk probability ranged from 0 to 0.78,the high-risk population identi-fied by the model fully covered the actual patients with poor outcomes.Conclusion Serum TRAF6 and FGF21 levels in pa-tients with liver cirrhosis and UGIB are associated with disease severity and prognosis.These two factors may serve as poten-tial therapeutic targets for this disease.