严重急性呼吸道综合征并发全身炎症反应综合征时的肝脏损害  

Clinical features of liver injury in SARS patients with system inflammatory reaction syndrome

作　　者：张晶[1] 赵军[1] 李三军[1] 单晶[1] 王芳[1] 段钟平[1] 

机构地区：[1]北京佑安医院人工肝中心,北京100054

出　　处：《临床肝胆病杂志》2003年第6期339-341,共3页Journal of Clinical Hepatology

基　　金：北京市科技计划重大项目 (H0 2 0 92 0 0 2 0 0 91);科教部国家科技攻关引导项目 ( 2 0 0 3BA75 3C)

摘　　要：探讨严重急性呼吸道综合征 (SARS)并发全身炎症反应综合征时肝脏损害的临床特点、可能的原因及机理。选择在我院住院的严重急性呼吸道综合征患者 12 8例。观察其临床表现特点 ,连续检测血常规、血气分析、肝肾功能和心肌酶谱等实验室指标 ,测定 32例患者血清炎症因子。部分患者行肝脏B型超声和尸检病理学检查。① 12 8例SARS患者中 ,97例存在除肺脏以外的其他脏器损害 ,以肝脏损害最常见 ;②转氨酶、心肌酶和炎症因子升高多见于发病后前 2周 ,并随着病情好转而下降 ;白蛋白进行性下降提示预后不良 ;肌酐和尿素氮持续增高主要出现于重型患者的晚期 ;③肝脏B型超声和病理学检查显示肝脏有非特异性炎症改变。SARS患者容易发生肝脏等实质脏器的损害 ,是全身炎症反应综合征的一部分 ,早期控制炎症反应综合征有助于延缓疾病进程 。To outline the clinical features of liver damage in severe acute respiratory syndrome (SARS) patients with systemic inflammatory reaction syndrome (SIRS), in order to elucidate the pathogenesis of SARS. Retrospective case series involving 128 patients with a certain diagnosis of SARS was included in our study, whose clinical and laboratory data were collected and analyzed. Serum inflammatory factors of 32 patients were determined by ELISA method in various stage of SARS. 10 cases were examined with B type ultrasound and autopsy of 3 cases were performed. ①Besides lung damage, abnormalities of other organs such as heart and kidney, especially liver, were found in 75.8% cases; ②Aminotransferase, cardiac enzymes and inflammatory factors elevated mainly in the first two weeks of SARS and decreased while recovery. Progressive decline of serum albumin indicated poor prognosis. Continuous high level of creatinine and urea nitrogen was seen in the end stage of some severe patients. ③Ultrasonic and pathological findings showed that there was non-specific inflammatory changes in liver. Liver injury is common in SARS which is a consequence of systemic inflammatory reaction syndrome. It may be beneficial to suppress the cytokine storm in patients of SARS with SIRS and to release pulmonary, hepatic, cardiac damage and improve their prognosis.

关 键 词：严重急性呼吸道综合征 全身炎症反应综合征 肝脏损害 并发症 血气分析 血常规 心肌酶谱 SARS 

分 类 号：R511.9[医药卫生—内科学]