Saibara T, Onishi S, Sone J, Yamamoto N, Shimahara Y, Mori K, Ozawa K, Yamamoto Y
First Department of Medicine, Kochi Medical School, Japan.
Transplantation. 1991 Apr;51(4):782-6. doi: 10.1097/00007890-199104000-00009.
Arterial ketone body ratio (AKBR [acetoacetate/beta-hydroxybutyrate]) was measured in nineteen patients under medical supportive therapy for fulminant hepatic failure (FHF), in order to evaluate its predictive value relative to liver transplantation. Of the 19 patients 8 (42%) were salvaged and 11 (58%) died. Seven of 8 survivors showed an increased AKBR over 0.6 at 24-hr after admission, and all of them showed AKBR over 0.8 at 48-hr with subsequent maintenance of the value over 1.0. By contrast, all 11 nonsurvivors demonstrated sustained suppression of AKBR below 0.4 from 24 to 72 hr after admission. AKBR values at 24 and 48 hr showed statistically significant differences between survivors and nonsurvivors. Neither the grade of portal systemic encephalopathy (PSE) nor other conventional laboratory parameters--such as AST, bilirubin, ammonia, prothrombin time, hepaplastin test, fibrinogen, and platelet count--could discriminate between survivors and nonsurvivors by univariate analysis. These results indicate that AKBR can accurately predict the prognosis of FHF at the initial 24-48 hr after admission, and that it can play an important role in setting the indication of FHF for liver transplantation.
为评估动脉酮体比率（AKBR [乙酰乙酸/β-羟基丁酸]）对暴发性肝衰竭（FHF）患者肝移植的预测价值，对19例接受医学支持治疗的FHF患者进行了该指标测定。19例患者中，8例（42%）存活，11例（58%）死亡。8例存活患者中，7例在入院后24小时AKBR升高至0.6以上，48小时时均超过0.8，且随后维持在1.0以上。相比之下，11例非存活患者在入院后24至72小时AKBR持续低于0.4。存活者与非存活者在24小时和48小时时的AKBR值存在统计学显著差异。单因素分析显示，门静脉性脑病（PSE）分级及其他传统实验室指标，如谷草转氨酶、胆红素、氨、凝血酶原时间、肝促凝血酶原激酶试验、纤维蛋白原和血小板计数，均无法区分存活者与非存活者。这些结果表明，AKBR可在入院后最初24 - 48小时准确预测FHF的预后，并在确定FHF肝移植指征方面发挥重要作用。
