劳力性热射病患者肝功能早期变化规律及其对预后判断的价值

Early changes in liver function and their prognostic value in patients with exertional heat stroke

目的探讨劳力性热射病（EHS）患者肝功能早期变化规律及其对预后判断的价值。方法回顾性收集2005-2013年10所部队医院收治的EHS患者69例,其中存活57例,死亡12例。统计患者发病后前10d血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、总胆红素（TBIL）、直接胆红素（DBIL）的变化情况,采用受试者工作特征曲线（ROC曲线）分析各项指标的最差值对于EHS患者预后判断的价值。结果 EHS患者血清转氨酶在发病第3~4天达到高峰后开始缓慢下降,血清胆红素在第5~8天达高峰后开始缓慢下降。死亡组的肝功能相关指标均高于相对应发病天数的存活组。发病早期血清转氨酶及胆红素对于预后判断具有较高的价值,其中ALT对于EHS患者死亡预测的ROC曲线下面积为0.833±0.064,最佳截断值为3016.5U/L;AST对于EHS患者死亡预测的ROC曲线下面积为0.798±0.073,最佳截断值为4745U/L;TBIL对于EHS患者死亡预测的ROC曲线下面积为0.810±0.067,最佳截断值为123.9μmol/L;DBIL对于EHS患者死亡预测的ROC曲线下面积为0.836±0.063,最佳截断值为87.42μmol/L。结论 EHS患者发病早期肝功能变化呈一定的规律性,各项指标的最差值对于患者的严重程度和预后具有较高的预测价值,提示当EHS患者的各项指标达到或高于该截断值时,死亡风险增高,需要引起重视。

Objective To explore the early changes in liver function and their prognostic value in patients with exertional heat stroke（EHS）. Methods The clinical data of sixty-nine patients with EHS admitted to 10 military hospitals from 2005 to 2013 were retrospectively analyzed. Among them 57 survived and 12 died. The levels of serum alanine aminotransferase（ALT）, aspartate aminotransferase（AST）, total bilirubin（TBIL） and direct bilirubin（DBIL） in the i rst 10 days at er the onset of heat stroke were detected. h e receiver operating characteristic（ROC） curve was plot ed to assess the prognostic value of the worst value of various parameters in patients with EHS. Results Serum aminotransferase reached the peak 3 to 4 days at er onset of EHS, and then it began to decline, and serum bilirubin reached the peak 5 to 8 days at er the onset, and then it began to decline slowly. h e relevant liver function indicators in death group were higher than those in survival group at corresponding days. Early onset of serum transaminases and bilirubin was found to have a high prognostic value, and the total area under the ROC curves of ALT for death judgment was 0.833±0.064, with the best diagnostic point as 3016.5U/L. h e total area under the ROC curves of AST for death judgment was 0.798±0.073, and the best diagnostic point was 4745U/L. h e total area under the ROC curves of TBIL for death judgment was 0.810±0.067, and the best diagnostic point was 123.9μmol/L. h e total area under the ROC curves of DBIL for death judgment was 0.836±0.063, and the best diagnostic point was 87.42μmol/L. Conclusions h e changes in liver function at early stage of EHS onset show certain regularity. h e worst value of relevant liver function indicators has a high predictive value for the severity of the ailment and its prognosis, and the i ndings remind us to pay more at ention to the risk of death when the value of liver function test reaches or higher than the best diagnostic level.