非对乙酰氨基酚相关急性肝衰竭患者的高乳酸血症
Hyperlactatemia in patients with non-acetaminophen-related acute liver failure.
作者信息
Taurá Pilar, Martinez-Palli Graciela, Martinez-Ocon Julia, Beltran Joan, Sanchez-Etayo Gerard, Balust Jaume, Anglada Teresa, Mas Antoni, Garcia-Valdecasas Juan-Carlos
机构信息
Department of Anesthesiology, Liver Transplant Unit, Hospital Clinic, Villarroel 170, Barcelona University, E-08036 Barcelona, Spain.
出版信息
World J Gastroenterol. 2006 Mar 28;12(12):1949-53. doi: 10.3748/wjg.v12.i12.1949.
AIM
To characterize hyperlactatemia in patients with non-acetaminophen acute liver failure (ALF) in an attempt to clarify the mechanisms implicated and the role as a prognosis factor.
METHODS
In the setting of liver transplantation, 63 consecutive patients with non-acetaminophen acute liver failure were studied in relation to tissue oxygenation, hemodynamic and metabolic parameters. Before and after transplantation, the number of infected patients and outcome were registered.
RESULTS
Acute ALF showed higher levels of lactate than subacute ALF (5.4+/- 1 mmol/L versus 2.2+/- 0.6 mmol/L, P=0.01). Oxygenation parameters were within the normal range. Lactate levels showed good correlation with respiratory quotient (r=0.759, P< 0.005), mean glucose administration (r=0.664, P=0.01) and encephalopathy (r=0.698, P=0.02), but not with splanchnic arteriovenous difference in PCO2, pH and the presence of infection (P=0.1). Portal vein lactate was higher (P< 0.05) than arterial and mixed venous lactate, suggesting its production of hyperlactatemia in the intestine and spleen. The presence of infection was an independent predictor of survival.
CONCLUSION
Hyperlactatemia is not a prognosis factor due to byproduct of the overall acceleration in glycolysis.
目的
对非对乙酰氨基酚急性肝衰竭（ALF）患者的高乳酸血症进行特征分析，以阐明其中涉及的机制及其作为预后因素的作用。
方法
在肝移植背景下，对63例连续的非对乙酰氨基酚急性肝衰竭患者的组织氧合、血流动力学和代谢参数进行了研究。记录移植前后感染患者的数量和预后情况。
结果
急性ALF患者的乳酸水平高于亚急性ALF患者（5.4±1 mmol/L对2.2±0.6 mmol/L，P = 0.01）。氧合参数在正常范围内。乳酸水平与呼吸商（r = 0.759，P < 0.005）、平均葡萄糖输注量（r = 0.664，P = 0.01）和肝性脑病（r = 0.698，P = 0.02）呈良好相关性，但与内脏动静脉二氧化碳分压差、pH值及感染情况无关（P = 0.1）。门静脉乳酸水平高于动脉血和混合静脉血乳酸水平（P < 0.05），提示肠道和脾脏产生了高乳酸血症。感染的存在是生存的独立预测因素。
结论
高乳酸血症并非糖酵解整体加速的副产物所致的预后因素。
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