脓毒症相关性急性肝损伤的流行病学特点及致病因素分析  

Analysis of epidemiological characteristics and pathogenic factors of sepsis-related acute liver injury

作　　者：张锦鑫 沈括 李俊杰 尹文 Zhang Jinxin;Shen Kuo;Li Junjie;Yin Wen(Department of Emergency Medicine,Xijing Hospital,Fourth Military Medical University,Xi’an 710032,China;Department of Burns and Cutaneous Surgery,Xijing Hospital,Fourth Military Medical University,Xi’an 710032,China)

机构地区：[1]空军军医大学第一附属医院急诊科,西安710032 [2]空军军医大学第一附属医院烧伤与皮肤外科,西安710032

出　　处：《中华急诊医学杂志》2022年第2期203-209,共7页Chinese Journal of Emergency Medicine

基　　金：军队后勤科研项目(AWS14C003-01);国家自然科学基金(81871587)。

摘　　要：目的通过收集脓毒症患者继发急性肝损伤的流行病学资料,分析其流行病学特点和高危因素并根据测序结果探讨脓毒症急性肝损伤的致病因素。方法选取2018年1月1日至2019年12月31日就诊于空军军医大学学第一附属医院急诊科288例脓毒症患者,根据是否发生急性肝损伤分为脓毒症肝损伤组(44例)和脓毒症无肝损伤组(244例),对比分析两组患者入科时的一般资料、血液学指标、病情严重程度等指标的差异,用Logistic回归分析脓毒症相关性肝损伤的高危因素。并选取8例脓毒症肝损伤患者、4例脓毒症非肝损伤患者,提取外周血单个核细胞组织核糖核酸(Ribonucleic Acid,RNA),采用RNA-seq进行检测,并对差异基因进行筛选并分析。结果与脓毒症无肝损伤组相比,肝损伤组患者罹患高血压更少(11.4%vs.30.3%)、慢性肾功能不全相对更多(40.9%vs.12.1%);因肾脏疾病入住急诊科的比例更多(43.2%vs.24.6%)、入院时贯序器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分更高[SOFA(分)(9.86±3.59)vs.(5.41±3.13),APACHEⅡ(分)(16.07±4.41)vs.(14.46±3.77)]、住院天数更多[d:8(4.75,13.75)vs.6(2,9)];呼吸系统和消化系统更易发生感染(70.5%vs.18.0%);感染金黄色葡萄球菌的几率更大(9.1%vs.2.0%);实验室指标[降钙素原(PCT)、乳酸脱氢酶(LDH)、部分凝血活酶时间(APTT)、直接胆红素(DBIL)、谷草转氨酶(ALT)、谷丙转氨酶(AST)]均明显升高[PCT(μg/L)(23.90±33.22)vs.(10.95±20.18),LDH(U/L)540.00(370.50,1177.00)vs.168.00(98.65,875.18),APTT(s)(41.50±3.13)vs.(36.23±5.27),DBIL(μmol/L)18.50(10.10,58.85)vs.10.30(7.60,16.85),ALT(U/L)67.00(41.25,164.00)vs.29.00(18.00,51.25),AST(U/L),101.00(51.25,174.75)vs.35.00(25.00,65.50)],而血小板(PLT)、白蛋白(Alb)较脓毒症无肝损伤组明显降低[PLT(×109/L)62.5(38.50,164.25)vs.90.50(66.25,165.50),Alb(g/L)(30.17±7.16)vs.(34.20±6.50)](均P<0.05)。Logistic回归分析发现,金黄色葡�Objective To analyze the epidemiological characteristics,high risk factors and pathogenic factors of sepsis-related liver injury patients by collecting epidemiological data and the sequencing results.Methods A total of 288 sepsis patients been admited to the Emergency Department of the First Affiliated Hospital of Air Force Military Medical University from January 1,2018 to December 31,2019 were selected and divided into sepsis liver injury group(n=44)and sepsis without liver injury group(n=244)according to whether acute liver injury occurred or not.The differences ofthe general data,hematological parameters,severity of illness and other indicators at admission between the two groups were compared and analyzed.Logistic regression was used to analyze the risk factors of sepsis-related liver injury.Total of 8 septic patients with liver injury and 4 septic patients without liver injury were selected for RNA-sequencing.Ribonucleic acid(RNA)was extracted from peripheral blood mononuclear cell of patients,detected using RNA-seq,and differential genes were screened and analyzed.Results Compared with the sepsis without liver injury group,patients in the liver injury group suffered less hypertension(11.4%vs.30.3%)and relatively more chronic renal insufficiency(40.9%vs.12.1%);more patients were admitted to the emergency department due to renal disease(43.2%vs.24.6%),higher sequential organ failure score(SOFA)and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score(SOFA(points)9.86±3.59 vs.5.41±3.13,APACHEⅡ(points)(16.07±4.41)vs.(14.46±3.77),with prolonged hospital days(d):8(4.75,13.75)vs.6(2,9)];in the liver injury group,the incidence of infection in respiratory and digestive systems(70.5%vs.18.0%)andthe chance of infection with Staphylococcus aureus were higher(9.1%vs.2.0%),and laboratory parameters(procalcitonin(PCT),lactate dehydrogenase(LDH),partial thromboplastin time(APTT),direct bilirubin(DBIL),aspartate aminotransferase(ALT),alanine aminotransferase(AST))were significantly increased[PCT(μg/L)(23

关 键 词：脓毒症 脓毒症相关性急性肝损伤 流行病学特点 致病因素 预后 生物标志物 基因 生物信息学分析 

分 类 号：R459.7[医药卫生—急诊医学] R575[医药卫生—治疗学] R181.3[医药卫生—临床医学]