PLASMA-EXCHANGE AND THE ARTERIAL BLOOD KETONE-BODY RATIO IN PATIENTS WITH ACUTE HEPATIC-FAILURE
PLASMA-EXCHANGE AND THE ARTERIAL BLOOD KETONE-BODY RATIO IN PATIENTS WITH ACUTE HEPATIC-FAILURE
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DOI：
10.1016/s0168-8278(05)80349-6
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发表时间：
1994-05-01
影响因子：
25.7
通讯作者：
YAMAMOTO, Y
中科院分区：
文献类型：
--
作者：
SAIBARA, T;MAEDA, T;YAMAMOTO, Y
肝细胞再生在急性肝功能衰竭中是恢复所必需的，但需要大量的能量。在这些病例中，血浆置换作为支持性治疗的一个问题是大量柠檬酸盐输注对肝脏能量负荷有不良影响，这可能是这些患者的严重风险。据报道，动脉血中乙酰乙酸与β-羟基丁酸的比值反映了肝细胞的细胞能荷。在这项研究中，在19例急性肝衰竭患者的血浆置换前后评估了这一比值。8例患者痊愈，11例死亡。所有II期死亡者的动脉血酮体比率均低于0.6。在第一次血浆置换期间，其中10人的血浆置换率降至0.4以下，其中7人的血浆置换率低于0.4超过12 h。另一方面，在首次血浆置换后12小时内，8例存活患者中有4例的动脉血酮体比恢复至0.6以上，仅8例患者中有2例的动脉血酮体比保持在0.4以下超过12小时。这些数据表明，血浆置换可能会导致严重急性肝衰竭患者的动脉酮体比抑制。这些代谢变化损害升代谢，并可能使有效的肝细胞再生不可能。(C)肝病学杂志。
Hepatocyte regeneration in acute hepatic failure is essential for recovery, but requires a large amount of energy. One problem with plasma exchange as supportive therapy in these cases is that massive citrate infusion has an adverse effect on the hepatic energy charge, which may be a serious risk in these patients. The ratio of acetoacetate to beta-hydroxybutyrate in arterial blood has been reported to reflect the cellular energy charge of hepatocytes. In this study, this ratio was assessed before and after plasma exchange in 19 patients with acute hepatic failure. Eight patients recovered and 11 died. The arterial blood ketone body ratio was below 0.6 in all II nonsurvivors. It fell to below 0.4 in 10 of them during the first plasma exchange session, and remained below 0.4 for over 12 h in seven of them. On the other hand, the arterial blood ketone body ratio returned to above 0.6 in four of eight surviving patients within 12 h after the first plasma exchange and remained below 0.4 for over 12 h only in two of eight patients. These data indicate that plasma exchange may cause suppression of the arterial ketone body ratio in patients with severe acute hepatic failure. These metabolic changes impair liter metabolism and may make effective hepatocyte regeneration impossible. (C) Journal of Hepatology.