Ozawa K, Kamiyama Y, Kimura K, Ukikusa M, Kono Y, Yamato T, Shimahara Y, Nakatani T, Asano M, Irie R, Kawashima S, Uchida K, Ohtoshi M, Aoyama H, Hirai F, Yasuda K, Tobe T
Artif Organs. 1982 Nov;6(4):433-46. doi: 10.1111/j.1525-1594.1982.tb04141.x.
The present study emphasizes the principle of using liver support to restore the blood ketone body ratio (acetoacetate/beta-hydroxybutyrate), which reflects the redox potential of liver mitochondria and correlates with hepatic energy charge (ATP + 0.5ADP/ATP + ADP + AMP). Eleven surgical patients with grade IV hepatic coma were treated by an ex vivo pig or baboon liver cross-hemodialysis with an interposed Cuprophan membrane when their blood ketone body ratios had decreased to below 0.4 compared with the normal of above 0.7. Three patients were treated by cross-hemodialysis using a standard Cuprophan membrane dialyzer without increase of blood ketone body ratio and without marked beneficial effect. However, five of eight patients who had blood ketone body ratios of above 0.25 became fully alert after treatment by cross-hemodialysis using the larger pore size and greater surface area Cuprophan membrane, concurrent with a rise in the decreased blood ketone body ratio, and three of them were later discharged. By contrast, in the three patients with blood ketone body ratios below 0.25, there was no restoration of consciousness and no improvement in their blood ketone body ratios by this liver support. It is suggested that, as long as the blood ketone body ratio remained over 0.25, this metabolic liver support is effective in restoring grade IV hepatic coma.
本研究强调了利用肝脏支持来恢复血酮体比值（乙酰乙酸/β-羟基丁酸）的原则，该比值反映了肝线粒体的氧化还原电位，并与肝脏能量电荷（ATP + 0.5ADP/ATP + ADP + AMP）相关。11名IV级肝昏迷手术患者，当他们的血酮体比值降至低于0.4（正常高于0.7）时，采用体外猪或狒狒肝脏交叉血液透析，并在其间插入铜仿膜进行治疗。3名患者使用标准铜仿膜透析器进行交叉血液透析治疗，血酮体比值未升高，也未产生明显有益效果。然而，8名血酮体比值高于0.25的患者中，有5名在使用孔径更大、表面积更大的铜仿膜进行交叉血液透析治疗后完全清醒，同时降低的血酮体比值有所上升，其中3名随后出院。相比之下，3名血酮体比值低于0.25的患者，通过这种肝脏支持治疗，意识未恢复，血酮体比值也未改善。提示只要血酮体比值保持在0.25以上，这种代谢性肝脏支持对于恢复IV级肝昏迷有效。
