Clowes G H, McDermott W V, Williams L F, Loda M, Menzoian J O, Pearl R
Surgery. 1984 Oct;96(4):675-85.
To measure the effects of cirrhosis on amino acid (AA) flux and to assess the value of the central plasma clearance rate of amino acids (CPCR-AA) as a hepatocyte function test, 35 patients with cirrhosis were studied before and after operation. Fourteen of these patients died after the operation. CPCR-AA measures the number of milliliters of plasma cleared of AA per minute by the liver and other visceral tissues. It is the ratio of AA entry rate into plasma (from peripheral tissues plus infusion) to the arterial AA plasma concentration. Preoperative CPCR-AA measurements in 21 fasted patients with cirrhosis who were not infected revealed a pattern of AA plasma concentration and exchange similar to that previously observed in patients with sepsis with normal liver function. Whereas the concentration of AA in both groups was slightly lower than normal, the CPCR-AA of each was more than four times that of normal postabsorptive people (p less than 0.01). However, preoperative values of CPCR-AA in patients with cirrhosis who survived was 220 +/- 26 ml/M2/min while that in those who died was 97 +/- 16 ml/M2/min (p less than 0.001). Postoperative measurements remained relatively unchanged: survivors 212 +/- 24 ml/M2/min and those who died 89 ml/M2/min (p less than 0.0005). Measurements in vitro of the hepatic protein synthetic rate in liver biopsy specimens taken at operation correlated well with CPCR-AA values obtained immediately before operation in 10 patients (r = 0.73; p less than 0.01). Thus in patients with cirrhosis visceral amino acid uptake and hepatic protein synthesis are maximally stimulated. Nevertheless, if the preoperative CPCR-AA does not approach the value of 284 +/- 76 ml/M2/min previously observed in patients with sepsis who recover, the patient with cirrhosis is prone postoperatively to die of overwhelming infection and multisystem failure.
为了测定肝硬化对氨基酸（AA）通量的影响，并评估氨基酸中央血浆清除率（CPCR - AA）作为肝细胞功能测试的价值，对35例肝硬化患者在手术前后进行了研究。其中14例患者术后死亡。CPCR - AA测量肝脏和其他内脏组织每分钟清除血浆中氨基酸的毫升数。它是氨基酸进入血浆的速率（来自外周组织加输注）与动脉血氨基酸血浆浓度的比值。对21例未感染的禁食肝硬化患者术前进行的CPCR - AA测量显示，氨基酸血浆浓度和交换模式与先前在肝功能正常的脓毒症患者中观察到的相似。虽然两组的氨基酸浓度均略低于正常水平，但每组的CPCR - AA均是正常吸收后人群的四倍多（p小于0.01）。然而，存活的肝硬化患者术前CPCR - AA值为220±26 ml/M2/分钟，而死亡患者为97±16 ml/M2/分钟（p小于0.001）。术后测量结果相对不变：存活者为212±24 ml/M2/分钟，死亡者为八十九ml/M2/分钟（p小于0.0005）。对手术时获取的肝活检标本进行的肝蛋白合成率体外测量与10例患者术前立即获得的CPCR - AA值相关性良好（r = 0.73；p小于0.01）。因此，在肝硬化患者中，内脏氨基酸摄取和肝蛋白合成受到最大程度的刺激。然而，如果术前CPCR - AA未接近先前在康复的脓毒症患者中观察到的284±76 ml/M2/分钟的值，肝硬化患者术后容易死于严重感染和多系统衰竭。
