Schiødt Frank V, Bangert Kristian, Shakil A Obaid, McCashland Timothy, Murray Natalie, Hay J Eileen, Lee William M
Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Liver Transpl. 2007 Sep;13(9):1324-9. doi: 10.1002/lt.21236.
Serum concentrations of the actin scavenger Gc-globulin may provide prognostic information in acute liver failure (ALF). The fraction of Gc-globulin not bound to actin is postulated to represent a better marker than total Gc-globulin but has been difficult to measure. We tested a new rapid assay for actin-free Gc-globulin to determine its prognostic value when compared with the King's College Hospital (KCH) criteria in a large number of patients with ALF. A total of 252 patients with varying etiologies from the U.S. ALF Study Group registry were included; the first 178 patients constituted the learning set, and the last 74 patients served as the validation set. Actin-free Gc-globulin was determined with a commercial enzyme-linked immunosorbent assay kit. The median (range) actin-free Gc-globulin level at admission for the learning set was significantly reduced compared with controls (47 [0-183] mg/L vs. 204 [101-365] mg/L, respectively, P < 0.001). Gc-globulin levels were significantly higher in spontaneous survivors than in patients who died or were transplanted (53 [0-129] mg/L vs. 37 [0-183] mg/L, P = 0.002). A receiver operating characteristic curve analysis showed that a 40 mg/L cutoff level carried the best prognostic information, yielding positive and negative predictive values of 68% and 67%, respectively, in the validation set. The corresponding figures for the KCH criteria were 72% and 64%. A new enzyme-linked immunosorbent assay for actin-free Gc-globulin provides the same (but not optimal) prognostic information as KCH criteria in a single measurement at admission.
肌动蛋白清除剂Gc球蛋白的血清浓度可能为急性肝衰竭（ALF）提供预后信息。未与肌动蛋白结合的Gc球蛋白部分被认为是比总Gc球蛋白更好的标志物，但一直难以测量。我们测试了一种新的无肌动蛋白Gc球蛋白快速检测方法，以确定与大量ALF患者的国王学院医院（KCH）标准相比时其预后价值。纳入了来自美国ALF研究组登记处的252例病因各异的患者；前178例患者构成学习集，后74例患者作为验证集。使用商业酶联免疫吸附测定试剂盒测定无肌动蛋白Gc球蛋白。学习集患者入院时无肌动蛋白Gc球蛋白水平的中位数（范围）与对照组相比显著降低（分别为47[0 - 183]mg/L和204[101 - 365]mg/L，P < 0.001）。自发存活者的Gc球蛋白水平显著高于死亡或接受移植的患者（53[0 - 129]mg/L对37[0 - 183]mg/L，P = 0.002）。受试者工作特征曲线分析表明，40 mg/L的临界值携带最佳预后信息，在验证集中阳性和阴性预测值分别为68%和67%。KCH标准的相应数字为72%和64%。一种新的无肌动蛋白Gc球蛋白酶联免疫吸附测定在入院时单次测量中提供与KCH标准相同（但非最佳）的预后信息。
