Increase of serum x1-acid glycoprotein despite the decline of liver synthetic function iin cirrhotics with hepatocellular carcinoma

α₁-Acid glycoprotein, an acute phase reactant synthesised by the liver, has been reported to be increased in neoplastic conditions and reduced in chronic liver disease. We measured serum α₁-acid glycoprotein by a nephelometric method in 186 subjects (112 males, 74 females): 55 had mild chronic liver disease (chronic hepatitis and steatofibrosis), 45 cirrhosis, 38 hepatocellular carcinoma, 15 extra-hepatic malignant disease; 33 healthy subjects were used as controls. Analysis of variance demonstrated a significant variability among groups (F = 17.08, P = 0.0000). Higher concentrations of α₁-acid glycoprotein were detected in malignant extra-hepatic disease than in all other groups (P < 0.01); concentrations of α₁-acid glycoprotein were higher in hepatocellular carcinoma than in cirrhosis (P < 0.01). Multiple regression analysis by groups (dependent variable = α₁-acid glycoprotein; group 1 = mild chronic liver disease + cirrhosis; group 2 = hepatocellular carcinoma) showed a significant correlation for both group 1 (r = 0.6264, F = 8.005, P = 0.0000) and group 2 (r = 0.8947, F = 13.643, P = 0.0000). The significant standardised regression coefficients were: cholinesterase, C-reactive protein, γ-glutamyltransferase and iron (negative) for regression upon group 1; C-reactive protein, α₁-antiproteinase, γ-glutamyltransferase, iron (negative) for regression upon group 2. A difference between the 2 regression equation coefficients was detected (F = 5.209, P = 0.0002). In conclusion, a raised α₁-acid glycoprotein concentration was found in patients with malignancies, both hepatic and extra-hepatic; however, patients with hepatocellular carcinoma had a lower α₁-acid glycoprotein concentration than patients with malignant extra-hepatic disease. In hepatocellular carcinoma, a good correlation existed between α₁-acid glycoprotein and other serum indices of the acute phase response. In some patients with hepatocellular carcinoma, α₁-acid glycoprotein was increased, despite the decrease of liver function.