Kawanishi K, Tada S, Kajikawa T, Ishida T
Department of Clinical Laboratory, Kagawa Medical University.
Rinsho Byori. 1998 Aug;46(8):804-12.
Lactate can be viewed as a metabolic dead end in that it can only be produced or utilized via pyruvate. Lactate production is determined primarily by pyruvate concentration and to a lesser extend by the redox state. Increased lactate production may result from tissue hypoxia, alkalosis, catecholamine and alanine transamination to pyruvate. Hyperlactatemia is observed in many pathological conditions. Current diagnostic criteria for lactic acidosis are a pH less than 7.35 and lactate concentration greater than 5 to 6 mmol/l. In our study series, malignancy was the most common underlying disease accompanied by lactic acidosis. Organ failure, cardiovascular disease and diabetes mellitus were also common. The prognosis of patients with these diseases were grave. In cases of lactic acidosis associated with diabetes mellitus, alcoholic liver disease, rhabdomyolysis and diabetic comas were noticeable as complications. Alcohol abuse was the most common cause of lactic acidosis associated with diabetes mellitus. In these cases, laboratory data showed prominent hyperlactatemia, hyperglycemia and acidemia and elevated anion gap. The mortality rate in these cases was 36% and higher in cases with organ failure. Treatment of lactic acidosis consists of alkalization by sodium bicarbonate with carbicarb, insulin-glucose-infusion, dichloroacetate therapy, tham administration, bicarbonate-buffered peritoneal dialysis and high bicarbonate-containing dialysis.
乳酸可被视为代谢终产物，因为它只能通过丙酮酸产生或被利用。乳酸的产生主要由丙酮酸浓度决定，在较小程度上受氧化还原状态影响。乳酸生成增加可能源于组织缺氧、碱中毒、儿茶酚胺以及丙氨酸转氨生成丙酮酸。高乳酸血症在许多病理状况下均可观察到。目前乳酸酸中毒的诊断标准是pH值小于7.35且乳酸浓度大于5至6毫摩尔/升。在我们的研究系列中，恶性肿瘤是伴随乳酸酸中毒最常见的基础疾病。器官衰竭、心血管疾病和糖尿病也很常见。这些疾病患者的预后很差。在与糖尿病相关的乳酸酸中毒病例中，酒精性肝病、横纹肌溶解症和糖尿病昏迷作为并发症较为显著。酒精滥用是与糖尿病相关的乳酸酸中毒最常见的病因。在这些病例中，实验室数据显示明显的高乳酸血症、高血糖症、酸血症以及阴离子间隙升高。这些病例的死亡率为36%，伴有器官衰竭的病例死亡率更高。乳酸酸中毒的治疗包括用碳酸氢钠和卡比卡林碱化、胰岛素 - 葡萄糖输注、二氯乙酸治疗、三羟甲基氨基甲烷给药、碳酸氢盐缓冲腹膜透析以及高含碳酸氢盐透析。
