肝病误用二甘醇后肝功能的变化及其与二甘醇中毒的关系

The effects of diethylene glycol on liver function

目的探讨慢性肝病患者误用静脉注射二甘醇后肝功能变化及其与二甘醇中毒发生的相关性。方法收集64例慢性肝病患者误用二甘醇前后的临床资料及8周内肝功能的动态变化情况，应用多因素回归分析二甘醇中毒的危险因素。结果64例慢性肝病患者误用静脉注射二甘醇后，15例（23．4％）出现急性肾小管坏死、酸中毒、中枢神经系统的中毒表现。12例（占中毒病例的80．0％，误用二甘醇病例的18．7％）在暴露后7d内死亡。静脉误用二甘醇后可引起轻度的肝损害，表现为早期（6周内）、一过性（1周）总胆红素加深、丙氨酸转氨酶轻度增高，胆碱酯酶轻度下降，而天冬氨酸氨基转移酶、Y谷氨酰转肽酶、碱性磷酸酶、总胆汁酸、胆固醇在使用前后及中毒组与无中毒组比较均未见明显差异。中毒组9例凝血酶原活动性下降，12例白蛋白下降（P〈0．05）。2例中毒患者出现腹胀加重，其中1例因消化道大出血死亡，另1例出现肝性脑病，最终需肝移植治疗。多因素回归分析显示，性别（中毒组全为男性，r=4．266，P〈0．05）及用二甘醇前黄疸水平（r=7．640，P〈0．01）与二甘醇中毒发生与否有关。结论误用静脉注射二甘醇后仅部分患者出现二甘醇中毒，但中毒者病死率极高。二甘醇可以加重肝功能损害，但多为轻度短暂肝功能变化，仅极少数发生二甘醇中毒的患者在出现肾损害同时出现肝病明显加重。

Objective To investigate the hepatotoxic effects of accidental intravenous diethylene glycol （DEG.） poisoning in patients with liver disease. Methods Clinical data and liver function results were obtained from 64 patients with liver diseases who had been accidentally treated with diethyl glycol-contami- nated agent and 45 cases with hepatorenal failure. The hepatotoxic effects of diethylene glycol DEG on the patients with liver diseases were assessed by multivariable logistical regression analysis. Results Of the 64 cases with liver diseases, 15 cases （23.4%） developed toxic presentations following the accidental administra- tion of DEG. All affected cases were male. Twelve of the 15 poisoned patients （80%）, died within 7 days of exposure to DEG. The most common clinical manifestations included kidney damage, renal failure, metabolic acidosis, and nerve system disturbances. The intravenous administration of DEG resulted in only mild liver function impairment. In terms of risk factors, both gender （r = 4.266, P 〈 0.05） and the severity of jaundice prior to DEG administration were related to the occurrence of toxin-induced renal failure （r = 7.640, P 〈 0.01）. Conclusions DEG may worsen liver damage in patients with liver diseases.