肝功能衰竭患者血清乳酸、苹果酸脱氢酶1水平变化及其与合并感染的关系  

Changes of serum lactate and MDH1 levels in liver failure patients and their relationship with infection

作　　者：郭金 石春霞 邓威 张璐懿 陈倩[1] 龚作炯[1] GUO Jin;SHI Chunxia;DENG Wei;ZHANG Luyi;CHEN Qian;GONG Zuojiong(Department of Infectious Disease,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院感染科,武汉430060

出　　处：《山东医药》2021年第24期29-33,共5页Shandong Medical Journal

基　　金：国家自然科学基金资助项目(82070609)。

摘　　要：目的观察肝功能衰竭(LF)患者血清乳酸、苹果酸脱氢酶1(MDH1)水平变化,并分析乳酸、MDH1与LF患者合并感染的关系。方法选取肝衰竭合并感染患者35例(合并组),肝衰竭患者40例(衰竭组),肝硬化患者40例(硬化组),体检健康者20例(正常组),比较各组血清乳酸、MDH1及凝血酶原活动度(PTA)、国际标准化比值(INR)、白细胞计数(WBC)、中性粒细胞比例(N%)、红细胞计数(RBC)、血红蛋白(Hb)、血小板计数(PLT)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白(ALB)、总胆红素(TBiL)、超敏C反应蛋白(hs-CRP),Pearson相关分析法分析4组血清乳酸、MDH1与临床生化指标的相关性,多因素Logistic回归分析法分析LF患者合并感染的危险因素。结果与正常组比较,合并组、衰竭组、硬化组血清乳酸水平升高,合并组、衰竭组血清MDH1水平升高(P均<0.05);与硬化组比较,合并组和衰竭组血清乳酸、MDH1水平升高(P均<0.05);与衰竭组比较,合并组血清乳酸、MDH1水平升高(P均<0.05)。与正常组比较,合并组、硬化组PTA降低,合并组、衰竭组INR升高,合并组及衰竭组和硬化组RBC、Hb、PLT降低(P均<0.05);与硬化组比较,合并组、衰竭组PTA降低,合并组、衰竭组INR升高,衰竭组RBC、Hb升高(P均<0.05)。与正常组比较,合并组、衰竭组、硬化组ALT、AST、TBiL、hs-CRP水平升高,ALB水平降低(P均<0.05);与硬化组比较,合并组和衰竭组ALT、AST、TBiL、hs-CRP水平升高(P均<0.05);与衰竭组比较,合并组ALT、AST水平降低,TBiL、hs-CRP水平升高(P均<0.05)。血清乳酸水平与MDH1(r=0.838)、TBiL(r=0.639)呈正相关,与PTA(r=-0.555)、ALB(r=-0.510)呈负相关,P均<0.05;MDH1水平与TBiL(r=0.581)、AST(r=0.427)、ALT(r=0.421)呈正相关,与PTA(r=-0.562)、ALB(r=-0.436)呈负相关,P均<0.05;MDH1与乳酸呈正相关(r=0.838,P<0.05)。乳酸≥5.71 mmol/L、MDH1≥939.90 mU/mL是LF患者发生感染的危险因素。结论 LF患者血清乳酸、MDH1水平升高Objective To observe the changes of serum lactate and malate dehydrogenase 1(MDH1) levels in patients with liver failure(LF),and to analyze the relationships between lactate,MDH1 and infection in LF patients.Methods Thirty-five patients with LF complicated with infection(combined group),40 LF patients(LF group),40 patients with liver cirrhosis(cirrhosis group),and 20 physically healthy controls(control group) were collected.We detected and compared the serum levels of lactic acid,MDH1 and prothrombin activity(PTA),international normalized ratio(INR),white blood cell count(WBC),neutrophil ratio(N%),red blood cell count(RBC),hemoglobin(Hb),platelet count(PLT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB),total bilirubin(TBiL),and C-reactive protein(CRP).Pearson correlation analysis was applied to analyze the correlation between lactate,MDH1 and clinical biochemical indexes;multivariate Logistic regression analysis was used to analyze the risk factors for infection of LF patients.Results Compared with the control group,the serum lactate and MDH1 levels increased in the combined group,LF group,cirrhosis group(all P<0.05);compared with the cirrhosis group,serum lactate and MDH1 levels increased in the combined group and LF group(both P<0.05);compared with the LF group,serum lactate and MDH1 levels increased in the combined group(both P<0.05).Compared with the control group,serum PTA levels decreased in the cirrhosis group and combined group,serum INR levels increased in the LF group and combined group,RBC,Hb,PLT levels decreased in the combined group,LF group and cirrhosis group(all P<0.05);compared with the cirrhosis group,serum PTA levels decreased and INR levels increased in the combined group and LF group,and RBC,Hb levels in the LF group increased(all P<0.05).Compared with the control group,serum ALT,AST,TBiL,hs-CRP levels increased,and ALB levels decreased in the combined group,LF group,and cirrhosis group(all P<0.05);compared with the cirhosis group,the serum ALT,AST,TBiL,hs-CRP lev

关 键 词：肝功能衰竭 乳酸 苹果酸脱氢酶1 感染 

分 类 号：R575.3[医药卫生—消化系统]