Department of Clinical Engineering, Kagoshima University Hospital, Kagoshima City, Japan.
Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima City, Japan.
Adv Exp Med Biol. 2024;1463:129-134. doi: 10.1007/978-3-031-67458-7_22.
Acute liver failure (ALF) is a disease associated with severe symptoms, including rapid deterioration of liver function and impaired consciousness. Recently, online hemodiafiltration (OLHDF), an artificial liver replacement therapy, has attracted attention as a treatment option for comatose ALF. In this study, changes over time in blood aromatic amino acids (AAAs) and ammonia (NH), the causative agents of hepatic coma, during OLHDF in patients with ALF were analysed. Nine patients aged 20 years or older with high-grade hepatic encephalopathy admitted to the Kagoshima University Hospital Emergency Centre between October 2020 and September 2021 were included. OLHDF settings were blood flow 100 mL/min, dialysate flow 300 mL/min, and replacement fluid flow 100 mL/min. The analysis items were blood NH concentration before and after OLHDF, blood amino acid concentration from before to 24 hours after the start of OLHDF, and the presence or absence of conscious awakening after OLHDF. Of the 11 amino acids measured in this study, the AAAs (tyrosine and phenylalanine) had concentrations higher than the reference range before the start of OLHDF, but were within the reference range 24 hours after OLHDF. NH was significantly reduced and the conscious awakening rate was 88.9%. When NH and AAAs, which were considered causative agents of hepatic coma and whose concentrations were higher than the reference range, were removed by OLHDF, the level of consciousness improved significantly. Regarding branched chain amino acids (BCAAs: valine, isoleucine, and leucine), which is considered a protective factor in hepatic coma, the concentration range before starting OLHDF was within the reference range, but the concentration 24 hours after starting OLHDF was below the reference range. The Fisher ratio, the ratio of BCAAs to AAAs, increased from before to after 24 hours starting OLHDF, but was lower than the reference range. Therefore, supplementation should be considered if OLHDF is continued for a longer period of time. Changes over time of 11 amino acids and NH in patients with ALF coma were analysed. NH and AAAs, which were abnormally high, decreased to within the reference range 24 hours after the start of OLHDF and the level of consciousness improved. On the other hand, BCAAs, which is considered a protective factor in hepatic coma, the concentration 24 hours after starting OLHDF was below the reference range. Further studies are needed to elucidate the changes in biologically useful substances during OLHDF.
急性肝衰竭（ALF）是一种伴有严重症状的疾病，包括肝功能迅速恶化和意识障碍。最近，在线血液透析滤过（OLHDF）作为肝昏迷 ALF 的治疗选择引起了关注。本研究分析了 ALF 患者 OLHDF 过程中血液芳香族氨基酸（AAA）和氨（NH）的变化，AAA 和 NH 是肝昏迷的致病因素。2020 年 10 月至 2021 年 9 月期间，九州大学医院急救中心收治的 9 名年龄在 20 岁及以上、高分级肝性脑病患者纳入本研究。OLHDF 设置为血流 100mL/min、透析液流量 300mL/min、置换液流量 100mL/min。分析项目包括 OLHDF 前后的血液 NH 浓度、OLHDF 开始后至 24 小时的血液氨基酸浓度以及 OLHDF 后的意识清醒情况。在本研究中测量的 11 种氨基酸中，AAA（酪氨酸和苯丙氨酸）在 OLHDF 开始前的浓度高于参考范围，但在 OLHDF 后 24 小时内处于参考范围。NH 显著降低，意识清醒率为 88.9%。当 OLHDF 去除被认为是肝昏迷致病因素且浓度高于参考范围的 NH 和 AAA 时，意识状态显著改善。关于支链氨基酸（BCAA：缬氨酸、异亮氨酸和亮氨酸），其被认为是肝昏迷的保护因素，OLHDF 开始前的浓度范围在参考范围内，但 OLHDF 开始后 24 小时的浓度低于参考范围。Fisher 比，即 BCAA 与 AAA 的比值，从 OLHDF 开始后 24 小时前到后增加，但低于参考范围。因此，如果长时间继续 OLHDF，则应考虑补充。分析了急性肝衰竭昏迷患者的 11 种氨基酸和 NH 的时间变化。NH 和 AAA 异常升高，在 OLHDF 开始后 24 小时内降至参考范围内，意识状态改善。另一方面，BCAA 被认为是肝昏迷的保护因素，OLHDF 开始后 24 小时的浓度低于参考范围。需要进一步研究阐明 OLHDF 期间生物有用物质的变化。
