严重急性呼吸综合征合并肝损害的临床及病理研究

Clinical features of liver injury in patients with severe acute respiratory syndrome

目的研究严重急性呼吸综合征(SARS)合并肝损害的临床及病理学特征。方法在病程不同时期,动态观察60例SARS患者肝功能指标变化情况,比较SARS重症组病例与普通组病例的肝损害差异。结果76.7%患者ALT升高(146.3±118.3)u/L、40.0%患者AST升高(81.3±29.8)u/L,30.0%患者Bil升高(35.3±15.6)μmol/L;病程第2周肝损害最多见。SARS重症组ALT,AST和Bil异常升高率高于普通组,但仅AST差异有显著性。激素治疗组与非激素治疗组间肝功能异常发生率的差异并无显著性。约93.5%患者经常规保肝治疗3周后肝功复常。1例尸检显示肝脏广泛轻度非特异炎症反应。结论SARS病人合并肝脏损伤相当普遍,表现为转氨酶的轻中度升高,少部分病例伴有胆红素的轻度异常,适当保肝治疗是必须的,也是有效的。

Objective: To study the clinical characteristics liver injury in patients with Severe Acute Respiratory Syndrome (SARS) and to explore its possible influence factors. Methods: The liver function of 60 patients with SARS were measured every 3 to 7 days. The common group and the severe group of SARS were compared. Results: The rates of abnormal serum ALT, AST, Bil were 76.7% (146.3±118.3) u/L, 40.0% (81.3±29.8) u/L, 30.0% (35.3±15.6)μmol/L respectively, The elevated variables occurred mostly in the second week after onset. Although the levels of ALT, AST, and Bil of severe group were higher than those of the common, there was a significant difference only in AST elevation rate between the two groups. Methylprednisolone did not probably result in abnormal liver function. The aminotransferases in 93.5% SARS patients normalized within three weeks. Pathological observation of one case showed only mild inflammation of liver. Conclusions: The liver injury of SARS patients can be found frequently, characterized by mild to moderate elevation of aminotransferases.