240例不同类型休克伴缺血性肝炎的临床资料分析  

Clinical analysis of 240 cases of different types patients of shock with ischemic hepatitis

作　　者：郑德权 符照康 李永超 ZHENG Dequan,FU Zhaokang,LI Yongchao(Department of Gastroenterology, Danzhou People’s Hospital, Danzhou 571700, Chin)

机构地区：[1]儋州市人民医院消化内科,海南儋州571700

出　　处：《胃肠病学和肝病学杂志》2018年第5期560-562,共3页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的分析不同类型休克引发缺血性肝炎(ischemic hepatitis,IH)患者的临床特征,探讨常见生化指标在预测该类患者病情发展中的作用。方法收集儋州市人民医院2010年5月至2015年5月240例不同类型休克(过敏性休克、低血容量性休克、感染性休克、心源性休克各60例)患者临床病例资料,对肝功能(ALT、AST、LDH、TBIL、ALP、γ-GT、Alb)、血清超敏C反应蛋白(CRP)、凝血酶原时间(PT)等指标进行分析。结果 144例(60.0%)休克患者伴发IH,4种休克类型患者所占比例依次为:感染性休克49例(34.0%)、心源性休克38例(26.4%)、过敏性休克30例(20.8%)、低血容量性休克27例(18.8%)。在4种休克类型中,ALT、AST、LDH、TBIL、γ-GT、CRP与正常值比较,差异有统计学意义(P<0.05)。Logistic回归分析显示,ALT>1 765.4 U/L、AST>1 839.6 U/L、LDH>1 034.8 U/L、CRP>37.9 mg/L是休克患者合并IH死亡的危险因素。结论感染性休克患者并发IH的概率更高,定量检测ALT、AST、LDH、CRP有助于对休克并发IH死亡率进行及时预测。Objective To analyze different clinical features of ischemic hepatitis（IH） caused by different types of shock,and investigate the effect of common biochemical indexes in predicting of progression of this disease. Methods The clinical datas of 240 patients diagnosed with shock（allergic shock,hypovolemic shock,septic shock,and cardiogenic shock,60 cases respectively） in Danzhou People＇s Hospital from May. 2010 to May. 2015 were collected. The parameters of liver function test,including alanine aminotransferanse（ALT）,aspartate aminotransferanse（AST）,lactate dehydrogenase（LDH）,total bilirubin（TBIL）,alkaline phosphatase（ALP）,γ-glutamyltransferase（γ-GT） and albumin（Alb）,were recorded and analyzed. Besides,the serum levels of C-reactive protein（CRP） and prothrombin time（PT） were also enrolled for analysis. Results Among all the cases,144（60. 0%） patients developed IH,with septic shock ranking on the top（49 cases,34. 0%） and hypovolemic shock as the lowest rate（27 cases,18. 8%）.Also,expression levels of ALT,AST,LDH,TBIL,γ-GT and CRP varied from different kinds of shock patients with significance（P〈0. 05）. Furthermore,ALT 1 765. 4 U/L,AST 1 839. 6 U/L,LDH 1 034. 8 U/L,CRP 37. 9 mg/L were carried out as risk factors for in-hospital mortality of IH in shock patients. Conclusion The septic shock is the most common cause of hepatic damage in shock patients. Quantitative detection of ALT,AST,LDH and CRP may serve as a useful tool for the mortality of IH in shock patients.

关 键 词：休克 缺血性肝炎 ALT AST LDH CRP 

分 类 号：R575[医药卫生—消化系统]