<Original Articles>Improved liver function following infusion of fructose-1, 6-bisphosphate in posthepatectomy patients

Abstract

The clinical effect of fructose-1, 6-bisphosphate (FBP) administered to posthepatectomy patients was examined . FBP at 0. 25 mmol/kg was administered continuously into the hepatic arter y for 60 minutes on the 1st postoperative day in 11 cases . Hepatic arterial infusion of 0. 25 mmol/kg glucose was performed in 7 cases. Furthermore, in 10 cases in which a catheter was not inserted in to the hepatic artery, 0. 25 mmol/kg FBP was administered intravenously over a 60-minute period. Arterial ketone body ratio (AKBR) and serum levels of cyclic adenosine monophosphate, immunoreactive insulin, inorganic phosphorus, glucose, fructose, pyruvate, lactate and pyruvate kinase (PK) in the arterial blood were measured before and after administration. AKBR hardly changed after hepati c arterial infusion of glucose. It rose until 3 hours after intravenous or intrahepatic arterial administration of FBP. Especially, after hepatic arterial infusion of FBP, the AKBR was significantly higher up to 2 hours after administration than that before administration (P < 0. 01). With hepatic arterial infusion of FBP, serum pyruvate tran sientl y increased immediately after infusion (P <0. 01). PK acti vity was significantly elevated after administration of FBP (P<0. 05). Serum lactate levels decreased significantly after hepatic arterial infusion of FBP (P <0. 05). There was no difference in the recovery of protein synthetic ability and the postoperative changes in serum liver function test values among the three groups. Hepatic arterial infusion of FBP was suggested to promote adenosine triphosphate production by acceleration of the glycolytic pathway and lactate uptake in the hepatic cell.

肝切除例に対して, 術後にfructose-1, 6-bisphosphate (FBP) を投与し, その臨床効果を検討した. 肝動脈内にカテーテルを留置した肝癌切除18例のうち, 11例に対して FBP 0. 25 mmol/kg を60分間持続肝動脈内投与し, glucose 0. 25 mmol/kg を肝動脈内に投与した7例を対照とした. なお, 肝動脈カテーテル非留置10例に対して, FBP 0. 25 mmol/kg を60分間持続全身投与した. 投与前後における AKBR, c-AMP, IRI, iP, glucose , fructose, pyruvate, lactate, pyruvate kinase (PK) の血中変化を測定し, 術後の肝機能検査値の推移を検討した. Glucose の肝動注ではAKBRはほとんど変化しなかったが, FBPは肝動注でも全身投与でも, 投与3時間後まで上昇した. とくにFBP肝動注では投与前値に比べ, 2時間後まで統計学的に有意に上昇した(P<0. 01). FBP の肝動注では，血清pyruvateはFBP投与直後に一過性に上昇し(P<0. 01), PK活性はFBP投与2時間後に有意に上昇していた(P<0. 05). また, 血清 Lactate はFBPの肝動脈内投与後有意に低下した(P<0. 05). 術後の肝逸脱酵素の推移や蛋白合成能の回復は3群で有意な差はなかった. 以上より, FBPの肝動脈内投与は肝細胞における解糖系亢進や乳酸摂取の亢進によりATP産生を促進する可能性が示唆された.