血清酶学指标对甲型H1N1流感患者疾病严重程度的预测价值研究

Value of Serum Enzymologic Indices for Predicting Severity of Patients with A /H1N1 Influenza

目的探讨甲型H1N1流感患者血清天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)水平与疾病严重程度的关系,为临床判断甲型H1N1流感患者轻重程度提供依据。方法分析2009年9—12月收治的206例甲型H1N1流感患者的AST、ALT以及肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)检验结果,依据《甲型H1N1流感诊疗方案(2009年第三版)》将患者分为轻症组、重症组、危重症组,对各组AST、ALT结果进行统计学分析。结果三组患者AST、ALT异常率间差异有统计学意义(P<0.01)。危重症组血清ALT(144.0±81.1)U/L高于重症组(27.6±2.8)U/L及轻症组(24.4±1.2)U/L,差异均有统计学意义(P<0.01)。危重症组AST(355.8±229.6)U/L高于重症组(64.2±8.5)U/L与轻症组(34.1±1.2)U/L,差异均有统计学意义(P<0.01)。Spearman相关分析显示,甲型H1N1流感患者危重程度与血清ALT、AST水平呈正相关(r=0.265、0.479,P=0.000)。结论甲型H1N1流感病毒感染后患者血清ALT、AST水平升高,ALT、AST是判断甲型H1N1流感患者疾病严重程度的有效指标。

Objective To investigate correlation of the severity of illness with the levels of serum alanine aminotransferase （ALT） and aspartate aminotransferase （AST） in patients with H1N1 influenza A virus infection so as to provide an evidence for assessing severity of illness clinically. Methods Totally 206 patients with A/H1 N1 influenza from September to December 2009 were recruited and divided as mild, severe and critical groups according to the treatment scheme of A/H1 N1 influenza. Their results of serum ALT, AST, creatine kinase （CK） and CK - MB was analyzed. Results Among the 3 groups the abnormal proportions of AST, ALT showed a significant difference （P 〈0.01） . The ALT value of （144.0 ±81.1） U/L in the critical group was higher than （27. 6 ±2. 8） U/L in the severity group and （24. 4 ± 1.2） U/L in the mild group （P 〈0.01 ） . And the AST value of （ 355.8 ± 229. 6） U/L in the critical group was higher than （64. 2 ± 8. 5 ） U/L in the severity group and （ 34.1 ± 1.2） U/L in the mild group （ P 〈 0. 01 ） . The Spearman correlation analysis revealed that the severity of patients with A H1 N1 influenza was positively correlated with AST and ALT levels （ r = 0. 265, 0. 479, P = 0. 000 ） . Conclusion The higher levels of serum ALT, AST of the patients with A/H1N1 influenza are the efficacious indices for judgment of the severity of illness.