Yamasaki H, Saibara T, Maeda T, Onishi S
First Department of Medicine, Kochi Medical School, Nankoku, Japan.
Liver. 1995 Aug;15(4):219-23. doi: 10.1111/j.1600-0676.1995.tb00674.x.
Hepatocyte regeneration is essential for recovery in acute hepatic failure, although it requires a large amount of energy. The ratio of acetoacetate to beta-hydroxybutyrate in arterial blood has been reported to reflect the cellular energy charge of hepatocytes, and we proposed that the recovery of the ratio in the early days of acute hepatic failure is essential for survival. However, there is no report on any marker of regeneration to confirm this hypothesis. In this study, we have assessed this ratio and the serum alpha-fetoprotein level sequentially in 26 patients with acute hepatic failure. Ten patients recovered and 16 died. The arterial blood ketone body ratio 3 days after the onset of hepatic encephalopathy of grade II or more was below 0.6 in 15 of the 16 nonsurvivors, whereas that in the 10 survivors was above 0.6. There was a positive correlation between the arterial blood ketone body ratio and the maximal concentration of alpha-fetoprotein (r = 0.465, p < 0.02 by Student's t-test). These data indicate that the arterial blood ketone body ratio is a marker for the capacity of the liver to regenerate and for the prognosis in patients with acute hepatic failure: effective hepatocyte regeneration may be impossible if these metabolic changes in acute hepatic failure impair the hepatocyte energy charge severely.
肝细胞再生对于急性肝衰竭的恢复至关重要，尽管这需要大量能量。据报道，动脉血中乙酰乙酸与β-羟基丁酸的比例可反映肝细胞的细胞能量状态，我们提出急性肝衰竭早期该比例的恢复对存活至关重要。然而，尚无关于任何再生标志物的报道来证实这一假设。在本研究中，我们对26例急性肝衰竭患者依次评估了该比例和血清甲胎蛋白水平。10例患者康复，16例死亡。在16例非存活者中，15例在出现二级或更高级别的肝性脑病3天后动脉血酮体比值低于0.6，而10例存活者的该比值高于0.6。动脉血酮体比值与甲胎蛋白的最大浓度之间存在正相关（r = 0.465，经学生t检验p < 0.02）。这些数据表明，动脉血酮体比值是急性肝衰竭患者肝脏再生能力和预后的标志物：如果急性肝衰竭中的这些代谢变化严重损害肝细胞能量状态，则有效的肝细胞再生可能无法实现。
