[The effects of altered hepatic energy metabolism as reflected by the blood ketone body ratio on plasma aminogram after the abdominal surgery].

The blood ketone body ratio (KBR), which reflects the liver mitochondrial redox state, and the plasma aminogram were measured postoperatively in 85 patients who underwent abdominal surgery at our Department. When the KBR of the patients was less than 0.4, the plasma concentrations of the total amino acids (TAA), the aromatic amino acids (AAA) and the branched chain amino acids (BCAA) were increased significantly compared with those when it was more than 0.7. The plasma concentrations of threonine, serine, glutamine, alanine, valine, asparagine, ornithine, glycine, cystine, methionine, leucine, tyrosine, phenylalanine, tryptophan, lysine and histidine were increased significantly when the KBR was less than 0.4 compared with those when it was more than 0.7. The molar ratios (MR) which indicate the ratio of BCAA to AAA were decreased significantly when the KBR was less than 0.4 compared with those when it was more than 0.7. In the 4 cases of prolonged decrease of KBR to less than 0.4 for 4 to 11 days postoperatively, the concentrations of the plasma amino acids listed above increased day by day. These phenomena suggest that the AAA and alanine, which are metabolized mainly by the liver, become hard to be metabolized when the KBR is less than 0.4. Furthermore, the increase in the other amino acids including BCAA, which are mainly metabolized by the peripheral tissue, may indicate an increase in peripheral proteolysis and a deterioration in the peripheral amino acids metabolism when the KBR is less than 0.4. The gradual postoperative increase in amino acids in those cases of prolonged decrease of KBR to less than 0.4 suggests that the decrease in the KBR, indicating a deterioration in the hepatic energy metabolism, precedes the increase in the plasma concentration of amino acids.