Fath J J, St Cyr J A, Konstantinides F N, Alden P, Ascher N L, Bianco R W, Foker J E, Cerra F B
Surgery. 1985 Sep;98(3):396-404.
Although decreases in hepatic adenosine triphosphate (ATP) levels during ischemia are thought to reflect loss of hepatic energy reserves and decreased viability, such changes have not been correlated with a clinically relevant index of hepatic function or viability. Ability to clear amino acids from plasma has been shown to correlate with function of the allograft in hepatic transplantation and survival after portal decompression in patients with hepatic cirrhosis. The effects of 60 minutes of warm ischemia in two groups of mongrel dogs were studied to assess the relationship between loss of ATP and amino acid clearance. One group (shunted) had portal decompression during the ischemic period and the other (portal stasis) did not. There was a significant correlation between loss of ATP and amino acid clearance after ischemia. Although the effects of ischemia on the liver were similar in both groups, the portal stasis group demonstrated significantly elevated SGOT levels during reperfusion that were related to impaired net adenine monophosphate synthesis and suggestive of ongoing injury. These data support the contention that loss of ATP during ischemia is associated with reduced functional capacity. In addition, they suggest that portal stasis produces toxic products that can impede hepatic recovery from ischemia.
虽然缺血期间肝脏三磷酸腺苷（ATP）水平的降低被认为反映了肝脏能量储备的丧失和生存能力的下降，但这种变化尚未与肝脏功能或生存能力的临床相关指标相关联。已证明从血浆中清除氨基酸的能力与肝移植中同种异体移植物的功能以及肝硬化患者门脉减压后的生存率相关。研究了两组杂种犬60分钟热缺血的影响，以评估ATP丧失与氨基酸清除之间的关系。一组（分流组）在缺血期进行门脉减压，另一组（门脉淤滞组）未进行。缺血后ATP丧失与氨基酸清除之间存在显著相关性。虽然两组中缺血对肝脏的影响相似，但门脉淤滞组在再灌注期间血清谷草转氨酶（SGOT）水平显著升高，这与单磷酸腺苷净合成受损有关，并提示存在持续损伤。这些数据支持了缺血期间ATP丧失与功能能力降低相关的论点。此外，它们表明门脉淤滞会产生有毒产物，从而阻碍肝脏从缺血中恢复。
