胡蜂蜇伤患者伤后1周肝功能变化特征及其影响因素分析

Characteristics and influencing factors of liver function in patients with wasp sting 1 week after injury

目的总结胡蜂蜇伤患者肝功能的临床特征并分析其影响因素。方法选取汉中市中心医院2014年7月至2021年8月收住院的378例胡蜂蜇伤患者为研究对象,对其临床资料进行回顾性分析,总结其伤后1周内肝功能变化的临床特征并分析其影响因素。结果伤后48 h内,总胆红素峰值占比94.8%(145/153),结合胆红素峰值占比89.1%(187/210),非结合胆红素峰值占比95.0%(113/119),丙氨酸转氨酶峰值占比39.5%(60/152),天冬氨酸转氨酶峰值占比76.4%(136/178);伤后48 h后,丙氨酸转氨酶及天冬氨酸转氨酶的峰值最高值及峰值中位数明显下降;在伤后第1个24 h内,蜇伤创面数≥30处、院前时间≤8 h在总胆红素、丙氨酸转氨酶正常及升高的患者间的差异具有统计学意义(P<0.05),性别、年龄差异无统计学意义(P>0.05);蜂蛰伤创面数、院前时间与伤后第1个24 h内的总胆红素水平存在相关性,但预测性较差。结论胡蜂蜇伤患者伤后总胆红素峰值、结合胆红素峰值、非结合胆红素峰值主要见于伤后48 h内。伤后48 h后丙氨酸转氨酶及天冬氨酸转氨酶峰值最高值、峰值中位数迅速下降。在伤后第1个24 h内,蜇伤创面数、院前时间是总胆红素及丙氨酸转氨酶升高的影响因素。

Objective To summarize the clinical characteristics of liver function in patients with wasp sting and analyze its influencing factors.Methods Three hundred and seventy-eight patients with wasp sting hospitalized in Hanzhong Central Hospital from July 2014 to August 2021 were selected as the research object.Their clinical data were retrospectively analyzed,the clinical characteristics of liver function changes within one week after injury were summarized,and their influencing factors were analyzed.Results Within 48 hours after injury,the peak value of total bilirubin accounted for 94.8%(145/153),the peak value of conjugated bilirubin accounted for 89.1%(187/210),the peak value of unconjugated bilirubin accounted for 95.0%(113/119),the peak value of alanine aminotransferase(ALT)accounted for 39.5%(60/152),and the peak value of aspartate aminotransferase(AST)accounted for 76.4%(136/178).After 48 hours after injury,the peak value and median value of ALT and AST decreased significantly.Within the first 24 hours after injury,the number of stung wounds≥30 and the pre-hospital time≤8 hours were statistically significant among patients with normal and elevated total bilirubin and alanine aminotransferase(P<0.05),but there was no significant difference in gender and age(P>0.05).The number of bee sting wounds and pre-hospital time were correlated with the level of total bilirubin within the first 24 hours after injury,but the prediction was poor.Conclusion The peak value of total bilirubin,conjugated bilirubin and unconjugated bilirubin in patients with wasp sting were mainly found within 48 hours after injury.After more than 48 hours of injury,the peak value and median value of ALT and AST decreased rapidly.With in the first 24 hours after injury,the number of stung wounds and pre-hospital time were the influencing factors of the increase of total bilirubin and alanine aminotransferase.