68例缺氧性肝炎患者临床特点、病因及预后分析

Clinical characteristics,etiology,and prognosis of hypoxic hepatitis: an analysis of 68 cases

目的对缺氧性肝炎患者的临床特点、病因及预后进行分析。方法收集2002年1月至2012年12月中国人民解放军第一六一医院病房收治的68例缺氧性肝炎患者的临床资料。分析缺氧性肝炎的常见病因。根据预后情况分为生存组及死亡组,对入院时年龄、性别、SOFA评分进行比较,入院后监测生化指标,并比较其峰值。计量资料符合正态分布的采用t检验;非正态分布者,采用秩和检验。结果导致缺氧性肝炎的常见原因依次为心力衰竭(急性心肌梗死、充血性)、呼吸衰竭、感染性休克、热休克、蜜蜂蛰伤。所有患者监测到的血清ALT及AST均急剧升高。住院期间(28 d)的短期病死率为33.8%。两组比较,入院时年龄(P<0.001)、SOFA值(P<0.001)、入院后胆红素(Bil)(P<0.001)、ALP(P<0.001、GGT(P=0.001)、凝血酶国际标准化比值(INR)(P<0.001)、乳酸脱氢酶(LDH)(P<0.001)、ALT(P=0.013)、BUN(P<0.001)等7项指标的差异具有统计学意义。治疗以纠正原发病为主,同时加强护肝、营养支持等综合治疗。结论缺氧性肝炎的预后较差,短期病死率高,死亡最常见的原因为心源性休克,其次为感染性休克及突发的心脏填塞。保护重要器官功能,预防感染等对改善预后具有重要作用。

Objective To investigate the clinical characteristics,etiology,and prognosis of hypoxic hepatitis （HH）.Methods The medical records of 68 patients with HH admitted to our hospital from January 2002 to December 2012 were collected and reviewed.The common causes of HH were analyzed.The patients were divided into groups of survival and death according to the clinical outcomes.The age,sex,and the Sequential Organ Failure Assessment （SOFA）score on admission were compared between groups.The clinical and laboratory data,including bil-irubin （Bil）,alkaline （ALP）,gamma -glutamyl transpeptidase （GGT）,international normalized ratio （INR）,lactate dehydrogenase （LDH）,alanine aminotransferase （ALT）,and blood urea nitrogen （BUN）,were monitored,and the peak of each parameter was compared between groups.Normally distributed continuous data were compared between the two groups using Student′s t-test,and non-normally dis-tributed continuous data were compared using rank sum test.Results The common causes of HH included heart failure （acute myocardial in-farction and congestive heart failure）,respiratory failure,septic shock,heat shock,and severe allergic reactions to bee sting.Sharply increas-ing levels of serum ALT and AST were observed in all patients.The 28-day in-hospital mortality rate was 33.8%.Significant differences be-tween two groups were observed in age of admission （P〈0.001）,SOFA value （P〈0.001）,and peak levels of Bil （P〈0.001）,ALP （P〈0.001）,GGT （P=0.001）,INR （P〈0.001）,LDH （P〈0.001）,ALT （P=0.013）,and BUN （P〈0.001）.The treatments of HH main-ly targeted the primary disease,while adjuvant therapies such as nutritional support and liver protection were also needed.Conclusion The prognosis of HH is poor and the mortality rate is high.The major cause of death is cardiogenic shock,followed by septic shock and acute myo-cardial infarction.Protecting vital organs from injury and preventing infection play important roles in improving the prognosis.