血清酮体比值判断感染性多脏器功能失常综合征病情严重程度及预后的意义

The significance of serum acetonic ketone body ratio in judgement of severity and prognosis of infectious multiple organ dysfunction syndrome

目的：探讨血清酮体比值（ＡＫＢＲ）对判断感染性多脏器功能失常综合征病情轻重程度和预后的意义。方法：测定正常对照组、肝硬化组、急性感染组（又分Ａ、Ｂ、Ｃ３组）患者乙酰乙酸（ＡｃＡｃ）、β羟丁酸（３ＨＢ）及ＡＫＢＲ等指标水平。结果：肝硬化组ＡｃＡｃ〔（０．４２±０．１５）ｍｍｏｌ／Ｌ〕和３ＨＢ〔（０．８２±０．１８）ｍｍｏｌ／Ｌ〕明显低于正常对照组〔（０．９９±０．２０）ｍｍｏｌ／Ｌ和（１．４０±０．２５）ｍｍｏｌ／Ｌ〕，Ｐ均＜０．０１；急性感染Ａ、Ｂ、Ｃ３组的ＰａＯ２、乳酸、阴离子间隙具有显著性差异（Ｐ均＜０．０１）；ＡＫＢＲ与ＡＰＡＣＨＥⅢ评分呈明显负相关（ｒ＝－０．８１２，Ｐ＜０．００１）；血清酮体水平与ＡＰＡＣＨＥⅢ评分间无明显直线相关关系（ｒ＝０．１６３，Ｐ＞０．０５）；ＡＫＢＲ和ＰａＯ２与ＡＰＡＣＨＥⅢ评分间有明显相关性（ｒ＝０．７２２，Ｐ＜０．０１）。结论：ＡＫＢＲ能更早期、直接、准确地反映肝细胞线粒体的受损程度和能量代谢状态，可以作为评估感染性ＭＯＤＳ病情严重程度及预后的重要指标。

Objective:To research the significance of serum acetonic ketone body ratio(AKBR) for judging the severity and prognosis of infectious multiple organ dysfunction syndrome(MODS).Methods:To determine the acetoacetic acid (AcAc),βhydroxybutyric acid (3HB) and AKBR levels in normal subjects,liver cirrhosis group and acute infection group,which was subdivided into A,B,C groups,respectively.Results:The AcAc content (0 42±0 15)mmol/L and 3HB concentration (0 82±0 18)mmol/L in liver cirrhosis group were lower obviously than those in normal subject group (0 99±0 20)mmol/L and (1 40±0 25)mmol/L,all P <0 01 ;PaO 2,lactic acid and anion gap were presented obviously difference among A,B,C groups of patients with acute infection (all P <0 001 ).There was an obvious negative correlation between AKBR level and acute physiology and chronic health evaluation Ⅲ (APACHE Ⅲ)( r = -0 812 , P <0 001 ).There was an obvious correlation between AKBR level and PaO 2 as well as APACHE Ⅲ( r =0 722, P <0 01).Conclusions:AKBR level can reflect directly,early and exactly the damage extent and energy metabolism of mitochondria in liver cell,so it was an important index for evaluating severity and prognosis of infectious MODS.