Acetaminophen Adducts Detected in Serum of Pediatric Patients With Acute Liver Failure.
Acetaminophen Adducts Detected in Serum of Pediatric Patients With Acute Liver Failure.
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在急性肝衰竭的儿科患者的血清中检测到的对乙酰氨基加合物。
DOI：
10.1097/mpg.0000000000000814
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发表时间：
2015-07
影响因子：
2.9
通讯作者：
Pediatric Acute Liver Failure Study Group
中科院分区：
文献类型：
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作者：
Alonso EM;James LP;Zhang S;Squires RH;Pediatric Acute Liver Failure Study Group
先前在急性肝衰竭患者中的研究分别在12%和19%的儿童和成人血清中发现了对乙酰氨基酚（APAP）蛋白加合物，急性肝衰竭的病因不明。本报告详细介绍了在儿科急性肝衰竭研究组（PALFSG）中不同诊断的患者亚组（n=393）中进行的APAP加合物检测。从PALFSG登记研究中纳入的393名参与者中获得血清样本。使用经验证的方法进行加合物测量。参与者按诊断类别分组为已知的APAP过量，已知的其他诊断和不确定的病因。根据各组内的加合物状态（阳性或阴性）比较人口统计学和临床特征以及参与者结局。APAP加合物检测在86%已知APAP过量的参与者中呈阳性，6%具有其他已知诊断，11%具有不确定的肝衰竭原因。加合物阳性患者血清丙氨酸氨基转移酶和天冬氨酸氨基转移酶显著升高，血清总胆红素显著低于加合物阴性患者。在不确定组中，加合物阳性患者的结局与加合物阴性患者不同（p=0.03），加合物阳性患者的自发生存率为16/21（76%），而加合物阴性患者的自发生存率为75/169（44%）。在已知诊断的患者中，加合物状态对预后无影响。需要进一步的研究来了解APAP暴露（由APAP加合物的存在确定）与急性肝衰竭儿童的临床表型和结局的关系。
Previous studies in patients with acute liver failure identified acetaminophen (APAP) protein adducts in the serum of 12% and 19% of children and adults, respectively, with acute liver failure of indeterminate etiology. This report details APAP adducts testing in a subset (n=393) of patients with varied diagnoses in the Pediatric Acute Liver Failure Study Group (PALFSG). Serum samples were available from 393 participants included in the PALFSG registry. Adducts measurement was performed using validated methods. Participants were grouped by diagnostic category as known APAP overdose, known other diagnosis and indeterminate etiology. Demographic and clinical characteristics and participant outcomes were compared by adducts status (positive or negative) within each group. APAP adducts testing was positive in 86% of participants with known APAP overdose, 6% with other known diagnoses and 11% with an indeterminate cause of liver failure. Adducts positive participants were noted to have marked elevation of serum alanine aminotransferase and aspartate aminotransferase coupled with total serum bilirubin that was significantly lower than adducts negative patients. In the indeterminate group, adducts positive patients had different outcomes than adducts negative patients (p=0.03), spontaneous survival was 16/21 (76%) in adducts positive versus 75/169 (44%) in adducts negative patients. Prognosis did not vary by adducts status in patients with known diagnoses. Further study is needed to understand the relationship of APAP exposure, as determined by the presence of APAP adducts, to the clinical phenotype and outcomes of children with acute liver failure.