非肝病性高血氨在重症患者中值得关注

Attention should be paid to non-hepatic hyperammonemia in severe patients

血氨作为体内氨基酸的主要代谢产物,在物质代谢和生物转化过程中发挥重要作用。现阶段的研究多是针对肝脏疾病导致的高血氨及氨中毒学说,而非肝脏疾病导致血氨增加的原因以及高血氨对于其他脏器功能的影响一直被忽视。无基础肝病(急性肝衰竭或慢性肝病),由其他原因引起的血氨增高被称为非肝病性高血氨(non-hepatic hyperammonemia,NHH),目前NHH尚未引起临床广泛重视。本文将针对重症患者发生NHH的病理生理机制、临床意义以及血氨与疾病的关系进行探讨,希望对相关疾病的临床诊断、病情评估和治疗有所启发。

As the main metabolite of amino acid in vivo,blood ammonia plays an important role in the process of material metabolism and biotransformation.Current studies tend to focus on the theory of high blood ammonia and ammonia poisoning caused by liver diseases,but the reasons for the increase of blood ammonia caused by non-liver diseases and the effects of high blood ammonia on other organ functions have been neglected.At present,it is believed that the increase of blood ammonia caused by other causes in patients without hepatic disease(acute liver failure or chronic liver disease)is referred to as non-hepatic hyperammonemia(NHH).However,at present,NHH has not been paid much attention by the clinicians.In this paper,the pathophysiological mechanism,clinical significance and the relationship between blood ammonia find disease in severe patients with NHH are discussed in the hope of that it will be helpful to clinical diagnosis,assessment and treatment of related diseases.