Stanford University, Stanford, California.
University of Texas Southwestern Medical Center, Dallas, Texas.
Liver Int. 2019 Dec;39(12):2368-2373. doi: 10.1111/liv.14216. Epub 2019 Sep 10.
Changes in Gc-globulin (Gc) and in alpha-foetoprotein (AFP) have been shown to be related to outcome in patients with acute liver failure (ALF). Gc is a serum protein that complexes with intravascular actin released during cellular necrosis. AFP, also made by hepatocytes, is associated with hepatocellular growth and regeneration. Previously, low absolute levels or decreases over time in either AFP or Gc portended to be a poor outcome.
In a retrospective analysis of the double-blind trial of intravenous N-acetylcysteine (NAC) for ALF not because of acetaminophen, sera on days 1 and 3 or days 2 and 4 following admission were available to measure AFP in 70 patients and Gc in 66 patients. Mann-Whitney U tests were performed on the admission values, the absolute change and the fractional change of AFP and Gc to compare TFS (transplant-free survival) and non-TFS (death or transplantation). Logistic regression and receiver operating characteristic (ROC) analyses were performed to evaluate the markers in comparison and in addition to King's College Criteria (KCC).
Transplant-free survival patients were characterized by increases in AFP, whereas non-TFS had significantly different (negative) absolute and fractional changes (P < .01). The addition of declining AFP levels to KCC improved the area under the curve in predicting non-TFS (AUC >70%). Gc globulin values did not differ between TFS and non-TFS in the 2-day intervals studied (P> .2).
In this comparison of two prognostic markers in patients with non-acetaminophen-induced ALF, rising AFP but not rising Gc levels was associated with TFS.
ClinicalTrials.gov number NCT00004467.
已有研究表明，在急性肝衰竭（ALF）患者中，Gc 球蛋白（Gc）和甲胎蛋白（AFP）的变化与预后相关。Gc 是一种血清蛋白，可与细胞坏死过程中释放的血管内肌动蛋白结合。AFP 也是由肝细胞产生的，与肝细胞的生长和再生有关。先前的研究表明，无论是 AFP 还是 Gc 的绝对值较低或随时间下降，都预示着预后不良。
在一项对乙酰半胱氨酸（NAC）治疗非对乙酰氨基酚所致 ALF 的双盲试验的回顾性分析中，70 例患者的入院第 1 天和第 3 天或第 2 天和第 4 天的血清中可测量 AFP，66 例患者的血清中可测量 Gc。采用 Mann-Whitney U 检验对入院时 AFP 和 Gc 的值、绝对值变化和分数变化进行比较，以比较 TFS（无肝移植生存）和非 TFS（死亡或移植）。进行逻辑回归和受试者工作特征（ROC）分析，以评估与 King 学院标准（KCC）相比的标志物。
TFS 患者的 AFP 水平升高，而非 TFS 患者的 AFP 水平绝对值和分数变化显著不同（阴性）（P <.01）。将 AFP 水平下降添加到 KCC 中可提高预测非 TFS 的曲线下面积（AUC >70%）。在所研究的 2 天间隔内，TFS 和非 TFS 之间的 Gc 球蛋白值无差异（P >.2）。
在比较两种非乙酰氨基酚诱导的 ALF 患者的预后标志物时，AFP 水平升高但 Gc 水平不升高与 TFS 相关。
ClinicalTrials.gov 编号 NCT00004467。
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