白毒伞中毒致肝损伤的酶学与凝血指标变化规律及其对预后的影响

The changes of liver function and coagulation parameters caused by Amanita verna poisoning-induced liver injury and its effect on prognosis

目的总结白毒伞中毒患者的临床特点,观察白毒伞中毒患者肝功能及凝血功能指标变化规律及其对预后的影响,探讨其在判断肝损伤程度、对预后的影响及指导临床治疗中的价值。方法回顾性分析42例因急性白毒伞中毒的住院患者临床特点及肝功能、凝血功能等指标的变化规律,比较白毒伞中毒死亡组与生存组肝功能和凝血功能变化特点。结果所有患者在食用白毒伞后6~12 h出现胃肠炎症状,表现为不同程度的呕吐、腹泻、腹痛,1~2 d后胃肠炎症状明显好转,后期出现黄疸、肝功能损伤,重症表现为谵妄、昏迷、多脏器功能衰竭;在中毒后3 d内,患者的谷丙转氨酶（ALT）和谷草转氨酶（AST）均显著升高,第3~4天达到高峰。ALT和（或）AST〉1 000 U/L为高峰界限,高峰持续时间平均为5 d,死亡组与生存组比较,差异有统计学意义（P〈0.05）。白毒伞中毒死亡组肝功能变化具有以下特征：ALT和AST在第3~5天持续增高,但在第7天下降,总胆红素（TBIL）则在第3~7天持续增高,出现胆酶分离,生存组则无此规律;凝血指标在早期也会升高,生存组血浆凝血酶原时间（PT）与部分凝血活酶时间（APTT）均值在食入白毒伞后初期略有升高,后期降至正常水平,死亡组均值在第4~6天升至最高值,其后没有明显下降,死亡组与生存组比较,差异有统计学意义（P〈0.05）;当出现胆酶分离、AST≥1 000 U/L且AST/ALT≥1.0、PTa≤40%、TBA≥50μmol/L提示患者预后不良,是影响患者预后的重要因素。结论动态观察白毒伞中毒患者肝脏功能及凝血功能指标变化,对判断肝损伤程度、预后判定有重要价值。

Objective To analyze the clinical characteristics of Amanita verna poisoning patients, and to observe the changs of liver function and coagulation function in Amanita verna poisoning patients, thereby to explore the clinical val- ue of coagulation parameters and liver function in prognosis in patients with Amanita verna poisoning. Methods The clinical manifestations and laboratory test indexs of 42 cases of acute Amanita verna poisoning were analyzed retrospectively, and the laboratory test indexs of blood obtained from Amanita verna poisoning death group and survival group were compared. Results After acute poisoning by Amanita verna appeared, the gastroenteritis symptoms, such as vom- iting, diarrhea, abdominal pain, and other serious complications were observed. The levels of alanine transarninase （ALT） and aspartate aminotransferase （AST） were increased in 3 days after eating Amanita verna. The level of ALT or AST larger than 1 000 U/L was the peak of transaminase, and this peak value could continue about 5 days. The levels of transaminase in death group had statistic significance compared with survival group （P 〈 0.05）. The liver function changes in death group showed the following characteristics： the AST and ALT levels continued to increase at the 3th day and 5th day, but dropped at the 7th day. In addition, TBIL continued to increase at the 3th the day, 5th day and 7th day. The survival group did not show any of these characteristics. APTT and PT were increased in death group than those in survival group （P 〈 0.05 ）. Bilirabin-enzyme separation, AST≥ 1 000 U/L and AST/ALT ≥ 1.0, PTa ≤40% , TBA ≥50 μmol/L were the major factors that influenced the prognosis in patients with Amanita verna poisoning-induced liver injury. Conclusion The changes of liver function and coagulation parameters are helpful to evaluate liver damage, estimate prognosis and guide treatment.