A study on arterial ketone body ratio(AKBR) and arterial ketone body concentration(KBC) in fulminant hepatitis.
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AKBR has been used as an indicator of hepatic mitochondrial function in fields of liver surgery such as liver transplantation and hepatectomy, and emergency and critical care medicine. The present study was undertaken to evaluate AKBR and KBC (acetoacetate+β-hydroxybutyrate) in patients with fulminant hepatitis. Twenty-six patients with fulminant hepatitis (14 with acute type and 12 with subacute type) were enrolled in this study. Arterial blood was sampled daily during their ICU stays and acetoacetate (ACAC) and β-hydroxybutyrate (BOHB) were measured and AKBR (ACAC/BOHB) and KBC were calculated. AKBR of the acute type and that of the subacute type on admission to the ICU were 0.39±0.22 and 0.94±0.31, respectively, indicating that acute type AKBR was significantly lower than that of the subacute type (p<0.001). In acute type, AKBR was observed to adequately reflect the severity of hepatic dysfunction and coma grade and the patterns of change in AKBR were observed to differ significantly between the survival and non-survival groups. On the other hand, in the subacute group, AKBR did not reflect the severity of hepatic dysfunction or coma grade and there was no significant difference in the patterns of change in AKBR between the survival and non-survival groups. KBC of the acute and subacute types were 130.2±96.9 and 46.5±27.0μmol/l, respectively. Thus, KBC in the acute type was significantly higher than that in the subacute type (p<0.02). However, the pattern of change in KBC did not differ between survivors and non-survivor in the subacute type. Furthermore, the pattern did not differ between the acute and subacute types. These results indicate that AKBR is applicable only to the acute type in evaluating hepatocyte function in fulminant hepatitis, but not to the subacute type, and that KBC should be evaluated based on the AKBR value.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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