82例AECOPD患者肝功能异常临床处置方案初探

Clinical analysis of 82 cases with damaged liver function of advanced chronic obstructive pulmonary disease

目的分析慢性阻塞性肺疾病急性加重(AECOPD)合并肝损害患者的临床特点、保肝治疗对其预后的影响。方法回顾性分析82例AECOPD合并肝损害者的外周血白细胞计数、中性粒细胞百分比、肝功能及动脉血气分析,并对治疗前后检验结果、住院天数、住院费用、肝功能转归和死亡率进行比较分析。结果 AECOPD患者治疗后症状、动脉血氧分压(PaO2)、外周血白细胞、中性粒细胞百分比和肝功能各参数值较治疗前均有明显改善(P<0.01);随pH值、PaO2、PaCO2指标的改善及感染的控制,肝功能亦逐渐恢复至正常。酸中毒时(pH<7.35)pH值与ALT、AST结果显著负相关,PaO2与ALT、AST结果显著负相关,PaCO2与ALT、AST结果显著正相关。结论 AECOPD患者肝脏功能有明显的损害,给予抗感染等原发病治疗,肝功能可恢复正常,但常规护肝降酶治疗对转归无显著影响。

Objective To explore the clinical characteristics and the etiology of 82 cases with damaged liver function of advanced chronic obstructive pulmonary disease（AECOPD）, and the influence of the live -protective therapy on the prognosis of the patients. Methods Retrospective analysis of 82 cases of advanced chronic obstructive pulmonary diseases （AECOPD） in our hospital was performed. The peripheral white blood cell count, liver function and arterial blood gas analysis were measured in patients with AECOPD. The association between the parameters of blood gas and liver function were analyzed by from beginning to end comparison, hospitalization duration, hospitalization cost, recovery of liver function, and mortality. When the respiratory acidosis of pH was less than 7.35, pH value was negatively correlated with ALT and AST. The PaO2 was negatively correlated with ALT and AST as well. Reversely, PaCO2 was positively correlated with ALT and AST. Results These parameters of peripheral white blood cell count, liver function and arterial blood gas analysis were remarkably improved （P〈0.01）. The recovery of liver function followed these parameters. Conclusion The liver function was impaired of advanced AECOPD. Treatment of anti-infection and support therapy of nutrition can retain the liver function of AECOPD. However liver- protective therapy exerts no effect on the prognosis of the patients.