Mackenjee M K, Kiepiela P, Cooper R, Coovadia H M
Arch Dis Child. 1982 Apr;57(4):277-82. doi: 10.1136/adc.57.4.277.
Clinically useful criteria were found by studying immunological functions on admission in 15 African children with acute hepatitis (AH) (11 of whom were HBsAg positive) and in 11 children with fulminant hepatic failure (FHF) (8 of whom were HBsAg positive), and by comparing these results with normal controls. Nine of the FHF patients died. All the AH patients survived despite the development of transient liver failure in seven. There was significant diminution of components of the classical and alternative pathways of complement and total haemolytic complement in FHF compared with AH, and in both groups in comparison with controls. Cellular immunity tested by phytohaemagglutinin and HBsAg transformation of lymphocytes and leucocyte migration inhibition with HBsAg, were more impaired in FHF than AH. These indices were reduced in both groups of patients compared with controls. The most important index correlating with severity of clinical disease was C3. It was lowest in FHF, but within this group was highest in 2 patients who survived, and in AH the C3 on admission was significantly lower in patients who subsequently showed signs of transient liver failure than in those who did not. The prothrombin index was less sensitive in differentiating serious from mild illness. It is suggested that C3 levels can be helpful in monitoring patients with acute liver disease.
通过研究15名患有急性肝炎（AH）的非洲儿童（其中11名HBsAg呈阳性）和11名患有暴发性肝衰竭（FHF）的儿童（其中8名HBsAg呈阳性）入院时的免疫功能，并将这些结果与正常对照组进行比较，发现了具有临床实用价值的标准。11名FHF患者死亡。所有AH患者均存活，尽管其中7人出现了短暂性肝衰竭。与AH相比，FHF患者经典和替代补体途径的成分以及总溶血补体显著减少，与对照组相比，两组均如此。通过植物血凝素检测的细胞免疫、淋巴细胞对HBsAg的转化以及HBsAg诱导的白细胞迁移抑制，FHF患者比AH患者受损更严重。与对照组相比，两组患者的这些指标均降低。与临床疾病严重程度相关的最重要指标是C3。它在FHF患者中最低，但在该组中，2名存活患者的C3最高，在AH患者中，随后出现短暂性肝衰竭迹象的患者入院时的C3显著低于未出现该迹象的患者。凝血酶原指数在区分重病和轻症方面不太敏感。建议C3水平有助于监测急性肝病患者。
