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Meaning of the supernormal level of arterial ketone body ratio(AKRB) during the phase recovering from a severe stress.

严重应激恢复阶段动脉酮体比值（AKRB）超常水平的意义。

基本信息

批准号：
12671510
负责人：
NAKATANI Toshio
金额：
$ 1.92万
依托单位：
Kansai Medical University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2000
资助国家：
日本
起止时间：
2000 至 2002
项目状态：
已结题

项目摘要

Arterial ketone body ratio(AKBR) which reflects hepatic mitochondrial redox status through arterial blood measurements was advocated in Japan, and has been widely determined in the fields of transplantation surgery, gastroentrological surgery, and emergency and critical care medicine. The lower limit of normal range of AKBR is considered to be 1.0. Various kinds of hepatic dysfunction occurs when AKBR is below the normal limit. On the other hand, when AKBR recovered to normal range, hepatic function was supposed to be recovered to normal.However, supernormal level of AKBR elevating to 2.5 or higher were observed in many cases in critical care medicine. There has been no discussion on the meaning of supernormal level of AKBR. In this study, I have studied the occurrence and meaning of supernormal level of AKBR. In many cases with severe stress insult such as hemorrhagic shock and severe sepsis, decreased AKBR not only recovers to normal range but continue to rise to supernormal level. I have studied the meaning of the supernormal level of AKBR in relation to SOFA score which is widely accepted as a diagnostic criteria of multiple organ failure. It is revealed that in many cases with supernormal AKBR level, SOFA score was higher than 10 points indicating that MOF was still on-going. This indicates that hepatic mitochondria are under hyperfunction to enhance energy generation that meets to the increased energy demand during the phase with AKBR supernormal level. It was considered that supernormal AKBR level reflects enhanced hepatic mitochondrial function to compensate the insufficient recovery of hepatocyte energy level.

动脉血酮体比(AKBR)是日本倡导的一种通过动脉血检测肝脏线粒体氧化还原状态的指标，在移植外科、胃体外科、急诊和重症监护医学等领域得到了广泛的应用。AKBR的正常范围下限被认为是1.0。当AKBR低于正常范围时，就会发生各种肝功能障碍。另一方面，当AKBR恢复到正常范围时，肝功能本应恢复正常，但在重症监护医学中，许多病例的AKBR超常水平升至2.5或更高。目前还没有关于AKBR超常水平的讨论。本研究对AKBR超常的发生及其意义进行了研究。在失血性休克、严重脓毒症等严重应激性损伤的患者中，AKBR下降不仅恢复到正常范围，而且继续上升到超常水平。我研究了AKBR超常水平与SOFA评分的关系，SOFA评分被广泛接受为多器官衰竭的诊断标准。结果显示，在AKBR水平异常的许多病例中，SOFA评分高于10分，表明MOF仍在进行中。这表明肝脏线粒体功能亢进，以增强能量生成，以满足AKBR超常期增加的能量需求。认为AKBR水平异常反映了肝线粒体功能增强，以补偿肝细胞能量水平恢复不足。