脓毒症患者肝功能变化与病情严重度及预后的关系

Relationship between hepatic alteration and severity and prognosis in the patients with sepsis

目的探讨脓毒症患者肝功能变化与病情严重度及预后的相关性。方法将2009年5月～2012年5月入住我院有完整临床资料的脓毒症患者126例分成死亡组（A组，n=35）和存活组（B组，n=91），分析比较两组患者主要肝功能指标的差异及主要肝功能指标异常与病情严重度（APACHE—m评分）的关系。同时，根据APACHE—Ⅲ评分的三分位数分为I组（n=16）、Ⅱ组（n=83）和Ⅲ组（n=27），分析比较不同分值组间肝功能主要指标的差异性。结果①死亡组患者与肝功能相关的主要指标：死亡组的总胆红素（TBIL）、谷丙转氨酶（A坍）、谷草转氨酶（AST）、总胆汁酸（TBA）明显高于存活组（P〈0．01），而白蛋白（ALB）、胆碱酯酶（CHE）明显低于存活组（P〈0．01）。@APACHE-Ⅲ评分Ⅲ组的TBIL、ALT、AST、TBA高于I、Ⅱ组（P〈0．01），而Ⅲ组的ALB、CHE低于I、Ⅱ组（P〈0．01）。③APACHE-Ⅲ评分与TBIL、ALT、AST、TBA呈正相关（P〈0．01），与ALB、CHE呈负相关（P〈0．01）。结论与肝功能相关的主要指标ALB、TBIL、ALT、AST、CHE和TBA的检测对判断脓毒症患者的预后及评估病情严重度有一定指导意义。

Objective To evaluate the relationship between heptic alteration and severity and prognosis in the patients with sepsis. Methods A total of 126 patients with sepsis in the central people＇s hospital of Huizhou from May 2009 to May 2012 were investigated,and divided into two groups according to survival（group A, n=35） or death （group B, n= 91）. The differences of heptic markers between the two groups were analyzed,and the relationship between the heptic markers and APACHE-HI score were studied. A total of 316 patients with first sepsis were stratified into quartile groups （ I to IV） defined by APACHE-m score. The relation between three groups and heptic markers in patients with sepsis were analyzed. Results （1）TBIL, ALT, AST, TBA of the death group were much higer than that of the survival group （P 〈 0.01）, and ALB, CHE were decreased in the death group （P 〈 0.01）. （2）Compared with group I ,Ⅲ, the levels of TBIL, ALT, AST, TBA in group Ⅲ（the highest group of APACHE- m score） were significantly increased （P 〈 0.01）, and ALB, CHE were significantly decreased in group Ⅲ （P 〈 0.01）. （3）There were positive correlations be- tween the APACHE-III score and TBIL, ALT, AST, TBA （P 〈 0.01）, there were negative correlation between A- PACHE-Ⅲ score and ALB, CHE （P 〈 0.01 ）. Conclusion ALB, TBIL, ALT, AST, CHE, TBA are assciated with the prognosis and severity of sepsis. Restoration of the disrupted heptic pathways may improve the prognosis of sepsis.