Pereira Stephen P, Rowbotham David, Fitt Sarah, Shearer Martin J, Wendon Julia, Williams Roger
Institute of Liver Studies, King's College Hospital, London, UK.
J Hepatol. 2005 Mar;42(3):365-70. doi: 10.1016/j.jhep.2004.11.030.
BACKGROUND/AIMS: In patients with severe acute liver dysfunction, i.v. phylloquinone (vitamin K1) may be given to exclude vitamin K deficiency, rather than impaired hepatic synthesis of coagulation factors alone, as the cause of the coagulopathy. However, there have been no studies of the pharmacokinetics or efficacy of i.v. or oral K1 in such patients.
49 adults with severe acute liver disease were randomised double-blind to a single 10 mg dose of i.v. or oral mixed-micellar K(1), or placebo. Serum levels of phylloquinone and undercarboxylated prothrombin (PIVKA-II) were assessed before and after treatment.
At admission, 13 patients (27%) had either low serum K1 levels or elevated PIVKA-II concentrations, indicative of subclinical vitamin K deficiency. In the 16 patients who received i.v. K1, there was one (6%) treatment failure (K1 rise <10 ng/ml above baseline), compared with 12 of the 15 (80%) who received oral K1 (P<0.0001). One patient in the placebo group developed overt vitamin K deficiency.
A minority of patients with severe acute liver dysfunction have subclinical vitamin K deficiency at the time of presentation, which is corrected by a single dose of i.v. K1. The intestinal absorption of mixed-micellar K1 is unreliable in adults with severe acute liver dysfunction.
背景/目的：对于重症急性肝功能不全患者，静脉注射叶绿醌（维生素K1）可用于排除维生素K缺乏，而非仅将凝血因子肝合成受损作为凝血病的病因。然而，尚无关于静脉注射或口服K1在此类患者中的药代动力学或疗效的研究。
49例重症急性肝病成人患者被随机双盲分为单次静脉注射或口服10mg混合微团K1或安慰剂组。治疗前后评估血清叶绿醌和脱羧基凝血酶原（PIVKA-II）水平。
入院时，13例患者（27%）血清K1水平低或PIVKA-II浓度升高，提示亚临床维生素K缺乏。在接受静脉注射K1的16例患者中，有1例（6%）治疗失败（K1升高<10ng/ml高于基线），而接受口服K1的15例中有12例（80%）治疗失败（P<0.0001）。安慰剂组有1例患者出现明显的维生素K缺乏。
少数重症急性肝功能不全患者在就诊时存在亚临床维生素K缺乏，单次静脉注射K1可纠正。混合微团K1在重症急性肝功能不全成人患者中的肠道吸收不可靠。
