肝叶切除术后代谢改变的临床研究

Metabolic Changes after Hepatolobectomy in Primary Liver Cancer Patients

用高效液相色谱法检测了１５例原发性肝癌行肝叶切除术及１５例胆囊切除术病人血浆游离氨基酸的含量。另外还检测了这些病人血清ＡＬＴ、ＡＳＴ、凝血酶原时间、纤维蛋白原、Ｖ因子、白蛋白、总蛋白及血清胆红素的含量。结果显示，肝癌病人血浆总氨基酸（ＴＡＡ）及支链氨基酸（ＢＣＡＡ）均低于对照，而芳香族氨基酸（ＡＡＡ）降低不明显，故ＢＣＡＡ／ＡＡＡ下降。行肝叶切除术后２４ｈ，ＢＣＡＡ降低，ＡＡＡ及ＴＡＡ均升高。此外，术后ＡＬＴ、ＡＳＴ及血胆红素均高于术前，而凝血酶原时间、Ｖ因子、纤维蛋白原、白蛋白及总蛋白均显著低于术前，这些参数大约于术后１～２周恢复至术前水平，提示氨基酸代谢紊乱可能由于恶性肿瘤引起，并由于手术切除而加重。术后短期内有一“代谢紊乱的危险阶段”，应设法尽早纠正。

Concentrations of fifteen plasma free amino acids from 15 primary liver cancer (PLC) patients of hepatolobectomy (Group H) were assayed by means of HPLC and compared with those from 15 patients of cholecystectomy (Group C). In addition, serum alanine transaminase (ALT), aspatate transaminase (AST), prothrombin time, proaecelerin, fibrinogen, albumin, total protein, serum bilirubin were also measured in group H. The results show that in PLC patients, plasma total amino acid (TAA), branched chain amino acid (BCAA) were lowered, while plasma aromatic amino acid (AAA) did not decrease significantly, thus resulting in a declination of the BCAA/AAA ratio. Twenty four hours after hepatolobectomy, there were a decrease of plasma BCAA and an increase of plasma AAA and TAA as compared with those preoperatively. On the first postoprative day, serum ALT, AST and serum blirubin were increased significandly, while prothrombin time, proacceterin, fibrinogen, albumin and total protein were decreased markedly. All these returned to the preoperative level about 1 2 weeks after herpatolobectomy. The above mentioned results disturbances of amino acid metabolism are resulted from hepatie malignancy. Hepatolobectomy may aggravate the amino acid metabolic disorder. Five to seven days after hepatolobectomy are considered to be a critcal period of metabolic disorder. Key work Metabolism Liver cancer Hepatolobectomy