重型肝炎患者内毒素血症与并发高乳酸血症和低血糖的关系  

Relationship and mechanism of coincidence among endotoxemia,hyperlactacidemia and hypoglycemia in severe hepatitis

作　　者：陈淼[1] 田德英[1] 周健[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院感染科,湖北武汉430030

出　　处：《中西医结合肝病杂志》2008年第2期86-87,90,共3页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

摘　　要：目的:探讨重型肝炎患者内毒素血症与并发高乳酸血症和低血糖的关系及机制。方法:48例慢性重型肝炎患者作为实验组,20例体检健康者为对照组,分别检测其血清内毒素、乳酸、血糖、总胆红素及乳酸脱氢酶的活力。结果:48例慢性重型肝炎患者低血糖发生率为52.2%,发生低血糖的患者内毒素水平为(1.87±0.91)EU/ml,正常血糖患者内毒素水平为(1.01±0.21)EU/ml,两者比较差异有显著性意义(P<0.05);高乳酸血症发生率为93.5%,发生高乳酸血症的患者内毒素水平为(1.85±0.92)EU/ml,正常乳酸水平的患者内毒素水平为(1.03±0.04)EU/ml,两者比较差异有显著性意义(P<0.05);48例患者中乳酸脱氢酶升高者有30例,占62.5%,其血清乳酸水平为(10.92±3.27)mmol/L,乳酸脱氢酶正常的患者乳酸水平为(6.51±0.47)mmol/L,两者比较差异有显著性意义(P<0.05);乳酸脱氢酶升高者血糖为(1.61±1.47)mmol/L,乳酸脱氢酶正常的患者血糖为(3.91±0.58)mmol/L,两者比较,差异有显著性意义(P<0.05)。20例正常人的血糖、乳酸、总胆红素值均在正常值参考范围内,与实验组比较,差异有显著性意义(P<0.05)。结论:重型肝炎患者出现严重的内毒素血症时可通过影响乳酸脱氢酶的活性而增强机体糖酵解功能,导致高乳酸血症和低血糖的发生。Objective： To approach the relationship and mechanism of coincidence among endotoxemia, hyperlactacidemia and hypoglycemia in severe hepatitis. Methods： The experimental group had 48 patients suffered chronic severe hepatitis, and 20 health adults were randomly selected as control group. Serum were collected and the values of endotoxin, lactic acid, blood glucose, total bilirubin and lactate dehydrogenase were detected. Results： The incidence rate of hypoglycemia was 52. 2% , in whom the value of endotoxin was （ 1.87±0.91 ） EU/ml, and the value of endotoxin in other euglycemic patients was （ 1.01±0. 21 ） EU/ml （ P 〈 0.05 ） . The incidence rate of hyperlactacidemia was 93. 5%, in whom the value of endotoxin was （ 1.85±0. 92 ） EU/ml, and the value of endotoxin in other nomal lactic acid patients was （ 1.03±0.04 ） EU/ml （ P 〈 0.05 ） . The value of lactate dehydrogenase was increased in 62. 5% patients. The value of lactic acid in them was （ 10.92±3. 27） mmol/L, and the value of lactic acid in other nomal lactate dehydrogenase patients was （6. 51±0.47 ） mmol/L （P 〈 0.05 ） . The value of blood glucose in patients whose value of lactate dehydrogenase was increased was （ 1.61±1.47 ） mmol/L, and the value of blood glucose in other nomal lactate dehydrogenase patients was （ 3. 91±0. 58 ） mmol/L （ P 〈 0. 05 ） . The values of lactic acid, blood glucose and total bilirubin in 20 health adults were all nomal. Conclusion ： The severe endotoxemia could strengthen glycolysis through affecting transcription of lactate dehydrogenase, reduced in hypoglycemia and hyperlactacidemia in severe hepatitis.

关 键 词：内毒素血症 高乳酸血症 乳酸脱氢酶 低血糖 慢性重型肝炎 

分 类 号：R575.1[医药卫生—消化系统]