Schiødt F V, Bondesen S, Petersen I, Dalhoff K, Ott P, Tygstrup N
Medical Department A, Division of Hepatology, Rigshospitalet, Copenhagen, Denmark.
Hepatology. 1996 Apr;23(4):713-8. doi: 10.1002/hep.510230409.
Gc-globulin scavenges actin released from necrotic hepatocytes to the extracellular space. In 77 patients with fulminant hepatic failure (FHF) (excluding patients treated with liver transplantation), admission levels of serum Gc-globulin and degree of complexing with monomeric actin (complex ratio) were determined to evaluate their predictive values in relation to survival/nonsurvival. Gc-globulin levels were significantly reduced in 47 nonsurvivors, compared with 30 survivors (96 +/- 71 mg/L vs. 169 +/- 101 mg/L, P < .001), whereas the complex ratio in nonsurvivors did not differ significantly from that of survivors. Gc-globulin levels were significantly lower in 59 patients with non-acetaminophen-induced FHF, compared with 18 patients with acetaminophen-induced FHF (P < .01). Using a cutoff level of serum Gc-globulin of 100 mg/L, a lesser value correctly predicted nonsurvival in 79 percent of patients with non-acetaminophen-induced FHF, whereas a higher value predicted survival in 60 percent. In patients with acetaminophen-induced FHF, nonsurvival was correctly predicted in 100 percent of patients and survival in 53 percent. In comparison, the King's College Hospital (KCH) criteria correctly predicted nonsurvival and survival in 69 percent and 57 percent, respectively, of the same non-acetaminophen-induced FHF patients and in 60 percent and 38 percent, respectively, of the acetaminophen-induced FHF patients. Thus, in our study population, the predictive properties of Gc-globulin were in the same range as the KCH criteria. An advantage of Gc-globulin is that it gives an estimate of the outcome already on admission. Acute liver transplantation should be considered in FHF patients with Gc-globulin less than 100 mg/L.
Gc球蛋白可清除从坏死肝细胞释放到细胞外空间的肌动蛋白。在77例暴发性肝衰竭（FHF）患者（不包括接受肝移植治疗的患者）中，测定血清Gc球蛋白的入院水平和与单体肌动蛋白的结合程度（结合率），以评估它们对生存/非生存的预测价值。与30例幸存者相比，47例非幸存者的Gc球蛋白水平显著降低（96±71mg/L对169±101mg/L，P<.001），而非幸存者的结合率与幸存者相比无显著差异。与18例对乙酰氨基酚诱导的FHF患者相比，59例非对乙酰氨基酚诱导的FHF患者的Gc球蛋白水平显著更低（P<.01）。使用血清Gc球蛋白临界值100mg/L时，较低值能正确预测79%的非对乙酰氨基酚诱导的FHF患者非生存，而较高值能预测60%的患者生存。在对乙酰氨基酚诱导的FHF患者中，100%的患者被正确预测非生存，53%的患者被正确预测生存。相比之下，国王学院医院（KCH）标准分别正确预测了相同的非对乙酰氨基酚诱导的FHF患者中69%的非生存和57%的生存，以及对乙酰氨基酚诱导的FHF患者中60%的非生存和38%的生存。因此，在我们的研究人群中，Gc球蛋白的预测特性与KCH标准处于同一范围。Gc球蛋白的一个优点是它在入院时就能对预后进行评估。对于Gc球蛋白低于100mg/L的FHF患者应考虑急性肝移植。
