急性胰腺炎肝功能损害临床分析

Acute pancreatitis accompanied by abnormal markers of liver function

目的:观察并分析肝功能指标与急性胰腺炎(AP)的病因和病情严重程度相关性的临床意义。方法:回顾性分析124例AP患者,根据临床表现、CT评分、C-反应蛋白(CRP)及(或)Ranson评分综合考虑,分为重症(SAP)和轻症(MAP)两组,同时根据CT或磁共振胰胆管造影术(MRCP)及(或)B超判断其属于胆源性AP还是非胆源性AP,进一步分析并探讨其肝功能试验结果与AP的病情严重程度相关性。结果:胆源性AP的丙氨酸转氨酶(ALT)、天冬氨酸转氨酸(AST)、γ-谷氨酰转移酶(GGT)异常发生率高于非胆源性AP,差异具显著性(P<0.01);SAP组的ALT、AST、碱性磷酸酶(ALP)、GGT、总胆红素(TBIL)异常的发生率虽高于MAP组,但差异无显著性(P>0.05)。所有肝功能指标都行非参数Wilcoxon秩和检验,胆源性AP组的ALT、AST、GGT、TBIL平均秩和均显著高于非胆源性AP组(P<0.01),ALP平均秩和显著高于非胆源性AP组(P<0.05);SAP组的ALT、AST、ALP、GGT、TBIL平均秩和虽均高于MAP组,但差异无显著性(P>0.05)。然而,SAP组的白蛋白(ALB)异常发生率明显高于MAP组,其差异具显著性(P<0.01),且SAP组的ALB平均秩和显著低于MAP组(P<0.01)。重症的胆源性AP组和重症的非胆源性AP组ALT、ASTTBIL平均秩和的差异呈显著性(P<0.05),而轻症的胆源性AP和轻症的非胆源性APALT、AST、GGT平均秩和的差异均有高度显著性(P<0.01)。结论:胆源性因素导致胆管压力升高在AP肝功能损害中起主要作用。胆源性AP的肝功能损害实质上可能是胆源性疾病同时并发AP和肝功能损害,而并非AP并发肝功能损害,因此用肝功能指标异常程度来判断胆源性AP的严重程度意义不大。

Objective To investigate and analyze the relationship between the markers of liver function and etiology and severity of acute pancreatitis （AP）. Methods A total of 124 patients with AP were retrospectively analyzed. The patients were divided into two groups, mild AP （MAP） group and severe AP （SAP） group in which the markers of liver function were analyzed. In these patients, the causes of the disease were also divided into two groups, biliary pancreatitis group and non-biliary pancreatitis group in which the markers of liver function were also analyzed. The relations between those markers and the severity of the disease were explored. Results The proportions of abnormal markers of alanine aminotransferase （ALT）, aspartate aminotransferase （AST） and ~/-glutamyl transferase （GGT） in biliary AP group were significantly higher than those in non-biliary AP group （P〈0.01）. All the liver function markers were carried out by Wilcoxon test statistically. The mean scores of such liver function markers as ALT, AST, GGT and total bilirubin （TBIL） in biliary AP group were significantly higher than those in the non-biliary AP group, respectively （P〈0.01）, and the mean score of alkaline phosphatase （ALP） was also significantly higher than that in the non-biliary AP group （P〈0.05）. The mean scores of such liver function markers as ALT, AST, ALP, GGT and TBIL in the SAP group were higher than those in the group respectively, but the differences did not reach statistical significance （P〉0.05）. However, The proportion of abnormal albumin （ALB） was significantly higher in SAP than that in MAP （P〈0.01）, and the mean score of ALB in SAP group was statistically lower than that in MAP （P〈0.01）. The differences of mean scores of such liver function markers as ALT, AST and TBIL in the severe type were significant between the biliary AP group and the non-biliary AP group （P〈0.05）, and those of such liver function markers as ALT, AST and GGT in the mild type were also significant between the biliary AP group and the non-biliary AP group （P〈0.05）. Conclusions The elevated pressure in the billiary tract is probably responsible for acute liver damage in the patients with AP. Acute liver damage accompanied by billiary AP, in essence, is probably due to the simultaneous concomitant manifestations of billiary diseases rather than acute liver damage complicated by billiary AP. Accordingly, it may be of little value to determine the severity of biliary AP by means of the level of abnormal liver function markers.