New evaluation of hepatic function before and hepatectomy:Total evaluation of the functions mitochodria,microsome and reticuloendothelial system.

为了评价肝切除前后反映肝功能的临床指标，我们同时测定了反映线粒体、微粒体和网状内皮系统功能的动脉酮体比率(AKBR)、7α-羟基胆固醇和纤维连接蛋白的变化。在硫代乙酰胺(TAA)诱导的肝硬变大鼠和正常大鼠70%肝切除前和术后1、2、7天分别采集动脉血，称重计算再生率。两组在1、2和3天的再生率无差异。两组大鼠肝切除前AKBR无明显差异，两组大鼠肝切除后第1天AKBR下降，第2天恢复，术后第7天AKBR显著低于正常大鼠，提示AKBR降低与肝硬变再生不良有关。7α-羟基胆固醇…TAA大鼠肝切除前、后EL均高于正常大鼠，两组大鼠肝切除后第1天7α-羟基胆固醇下降，第3天恢复至术前水平，第7天正常大鼠显著高于术前水平，而TAA大鼠无明显差异。TAA大鼠肝切除前后纤维连接蛋白水平均低于正常大鼠。肝切除后1~3天，两组大鼠肝微粒体酶活性均升高，第7天恢复至正常水平。这些变化可能先于网状内皮细胞激活，但与再生速率无关。所有患者术前AKBR正常(&gt；1.0)，术中AKBR下降，术后第3天恢复。然而，其中一名患者后来出现肝功能衰竭，表明AKBR的一过性升高不足以恢复。7α-羟基胆固醇和纤维连接蛋白的水平差异很大，这些变化主要是由于输血造成的，因此这些水平不太可能反映微生物体和网状内皮系统的确切功能。较少

To evaluate the clnical index reflecting liver function before and after hepatectomy,we simultaneously determined changes in arterial ketone body ratio(AKBR),7alpha-hydroxycholesterol and fibronectin,which are known to reflect the function of mitochondria,microsome and reticuloendothelial system,respectively.Arterial blood was obtained before and on 1,2.3 and 7 days after 70% hepatectomy in thioacetamide(TAA)-induced cirrhotic and normal rats.The liver was weighed to calculate regeneration rate.The regeneration rate on 1,2 and 3 days was not different between two groups,but on the 7th day was significantly lower in TAA rats than normal rats.AKBR did not differ between two groups before hepatectomy.AKBR decreased on the 1st day and recovered on the 2nd day after hepatectomy in both groups.On the 7th day after hepatectomy AKBR was significantly lower in TAA rats than normal rats,suggesting that lower AKBR related with poor regeneration in cirrhotic liver.The 7alpha-hydroxycholesterol lev … More el was higher in TAA rats than normal rats before and after hepatectomy.In both groups 7alpha-hydroxycholesterol was decreased on the 1st day but recovered to the preoperative level on the 3rd day after hepatectomy.On the 7th day after hepatectomy 7alpha-hydroxycholesterol was significantly higher than the preoperative level in normal rats,whereas it was not different in TAA rats. The elevation of microsomal enzyme activity might be paralleled with liver regeneration.Fibronectin levels were lower before and after hepatectomy in TAA rats than normal rats.After hepatectomy fibronectin was elevated on 1-3 days and returned to normal level on the 7th day in both groups.These changes might precede reticuloendothelial activation but were not related with the regeneration rate.We also determined these three parameter levels in patients who hepatectomized more than 2-segments. In all patients,AKBR was normal (>1.0)before hepatectomy and decreased on the operation day and recovered on the 3rd day after hepatectomy. However,one of the patients failed to liver failure later,indicating that transient elevation of AKBR is not enough for the recovery.The levels of 7alpha-hydroxycholesterol and fibronectin were widely varied.These variations were mainly due to transfusion,and therefore these levels are not likely to reflect the exact functions of microsome and reticuloendothelial system. Less