摘要
Objectives Partial hepatectomy induces a rapid transformation within the remnant liver, prompting a wave of hepatocyte mitosis which abates when the lost cell mass has been recovered. The mechanism of co-ordinated control of metabolism and maintenance of function during this period of dynamic change is incompletely understood. Furthermore, the biochemical basis of growth regulation in the regenerating liver has not been well defined. We have studied human liver regeneration using in vivo 31-phosphorus magnetic resonance spectroscopy (31 P MRS). This non-invasive technique allows assay of high-energy phosphate compounds and also of phospholipid metabolites thought to be involved in cellular renewal processes.Methods Five patients undergoing liver resection were studied. Hepatic metabolism was evaluated using 31P MRS before surgery and on postoperative days 2,4,6 and 14. Estimation of liver volume by magnetic resonance imaging and blood sampling for biochemistry were performed at the same time points.Results We found that the regenerative response following loss of liver parenchyma produced a reversible decline in energy state which necessitated compensatory adjustments in liver synthetic and excretory (unctions. Volume regain was associated with alterations in phospholipid metabolism, which normalized when the hepatic growth spurt was completed.Conclusion These observations indicate that modulation of hepatocyte energy economy is necessary for the integrated recovery of liver cell mass and function. We propose that deficient hepatic energy production may explain the mechanism of liver failure after hepatectomy, and suggest that in vivo measurement of liver metabolism may provide a rational basis for the development and evaluation of hepatic support strategies.
