肝病患者静脉二甘醇中毒的临床特点、实验室检查及影像学表现

Clinical features, laboratory findings and imaging appearances of venous diethylene glycol poisoning in patients with fiver disease

目的总结报道肝病患者静脉二甘醇中毒的临床特点、实验室检查及影像学表现。方法分析总结15例肝病患者静脉二甘醇中毒的临床特点，比较分析中毒前后的实验室检查结果及影像学表现。结果中毒病例均出现少尿型急性肾功能衰竭，平均6d后出现无尿。13例平均9d后CO，结合力下降，10d达谷值，代谢性酸中毒。11例平均9d后出现胃肠道症状或胃肠道症状加重。10例平均14d后出现神经系统损害。7例平均6d后出现低热。14例死亡，原因包括多器官功能障碍综合征、肺部严重感染、消化道大出血。血清肌酐、尿素氮平均5d异常，11、14d分别达峰值。血清钙无明显变化，血清磷明显升高。肝功能未见明显变化。白细胞增高，红细胞、血红蛋白降低。7例肺部影像学表现为轻度、中度及重度片状实变影，其中2例胃肠道轻度或重度积气、扩张。结论肝病患者静脉二甘醇中毒的主要特点为少尿型急性肾功能衰竭、代谢性酸中毒、胃肠道症状或胃肠道症状加重、神经系统损害及低热；中毒病死率93．33％；白细胞增高、贫血；肺部片状实变影；胃肠道积气扩张比肺部轻度片状实变影出现晚，比中度片状实变影出现早。

Objective To summarize and report the clinical features, laboratory findings and imaging appearances of venous diethylene glycol poisoning in patients with liver disease. Methods The clinical features of 15 venous diethylene glycol poisoning patients with liver disease were analyzed and summarized, their laboratory findings and imaging appearances were comparative analyzed before and after poisoning. Results All poisoned patients presented oliguric acute renal failure with anuria after a mean of 6 days. Carbon dioxide combination power of 13 patients was dropped after a mean of 9 days with trough value at the 10th day, and metabolic acidosis was developed. Gastroenteric symptoms or aggravation of gastroenterlc symptoms were displayed in 11 patients after a mean of 9 days. Neurological system impairment was observed in 10 patients after a mean of 14 days. Seven patients had low fever after a mean of 6 days. Causes of death of 14 patients included multiple organ dysfunction syndrome, severe lung infection and massive haemorrhage of digestive tract. Blood creatinine and urea nitrogen were abnormal after a mean of 5 days with peak value at the llth and 14th days respectively. Serum calcium had no obvious change, and phosphorus was increased distinctly. Liver functions did not change significantly. Poisoned patients had higher white blood cell counts, lower red blood cell counts and hemoglobin value. Of the 7 patients exhibited mild, moderate and severe patchy consolidation shadowing in the lung, 2 manifested mild or severe gaseous distention and dilation of gastroenteric tract. Conclusion Main features of venous diethylene glycol poisoning in patients with liver disease include oliguric acute renal failure, metabolic acidosis, gastroenteric symptoms or aggravation of gastroenteric symptoms, neurological system impairment and low fever, with a mortality of 93.33% of poisoned patients; higher white blood cell counts and anemia; patchy consolidation shadowing in the lung; gaseous distention and dilation of gastroenteric tract, which occures later than mild patchy consolidation shadowing and earlier than moderate patchy consolidation shadowing do in the lung.