肝脏合成功能障碍在脓毒症不同病原学类型间的差异

Differences of Hepatic Synthesis Dysfunction Among Different Etiological Types of Sepsis

分析肝脏合成功能障碍在脓毒症不同病原学类型间的差异,为早期评估脓毒症患者肝脏功能障碍程度和治疗提供参考。回顾性分析2017-2019年广西医科大学第一附属医院收治的144例脓毒症患者,收集患者的血清凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、总蛋白(TP)、球蛋白(GLO)、白蛋白(ALB)、前白蛋白(PAB)、血清胆碱酯酶(CHE),按照革兰氏阳性菌组(G^(+))、革兰氏阴性菌组(G^(-))及真菌组进行分组比较。PT在三组间比较,G^(-)组时间延长显著(P<0.05),G^(+)组与G^(-)组比较(P<0.05),真菌组与G^(+)、G^(-)组比较(P>0.05)。APTT在三组间比较(P<0.05),真菌组APTT的时间延长显著(P<0.05),真菌组与G^(+)、G^(-)组比较(P<0.05),G^(+)组与G^(-)组比较(P>0.05)。TP浓度在三组间比较(P<0.05),TP浓度在真菌组中下降最显著(P<0.05),G^(+)组与G^(-)组比较(P>0.05),G^(+)组与真菌组比较(P>0.05),G^(-)组与真菌组比较(P<0.05)。GLO浓度在三组间比较(P=0.05),G^(-)组中GLO浓度下降最显著,G^(+)组与G^(-)组比较(P>0.05),G^(+)组与真菌组比较(P<0.05),G^(-)与真菌组比较(P>0.05)。ALB在三组间比较差异不显著(P>0.05)。PAB浓度在三组间比较差异显著(P<0.05),PAB浓度在G^(-)组及真菌组中下降显著(P>0.05)。CHE在三组间比较(P>0.05),CHE在G^(-)及真菌组中的下降程度较G^(+)组显著(P>0.05)。本研究证实了肝脏合成功能在G^(-)组及真菌组中受损较G^(+)组严重。临床上应密切检测脓毒症患者的肝功能变化,及时评估其病情的严重程度,及时制定出合理的治疗方案。

The study analyzes the differences of liver synthesis dysfunction among different etiological types of sepsis,so as to provide reference for early assessment and treatment of liver dysfunction in sepsis patients.Then the study retrospectively analyzes 144 patients with sepsis in The First People’s Hospital of Nanning from 2017 to 2019,collects PT,APTT,TP,GLO,ALB,PAB and CHE.Comparison is done according to G^(+),G^(-)and fungus group.The time extension of PT in G^(-)group is significant(P<0.05).There is statistically significant difference in G^(+)and G^(-)group(P<0.05),fungus and G^(+),fungus and G^(-)group(P<0.05)in PT.There is statistically significant difference in APTT in three groups(P<0.05).The time extension in fungus and APTT group is significant(P<0.05),fugus,G^(+)and G^(-)(P<0.05),G^(+)and G^(-)group(P>0.05).In the comparison of GLO in three groups,GLO density in G^(-)group decreases significantly,with G^(+)and G^(-)group(P>0.05),G^(+)and fungus group(P<0.05),G^(-)and fungus group(P>0.05).There is no statistically significant difference in ALB in three groups(P>0.05).In the comparison of ALB in three groups,there is no statistically significant difference(P>0.05).There is statistically significant difference in PAB in three groups(P<0.05).The decrease of PAB concentration in CHE in G^(-)and fungus group is more significant(P>0.05).In the comparison of CHE in three groups,the decrease of CHE in G^(-)and fungus group is more significant than that in G^(+)group(P>0.05).The study confirms that liver synthesis function is more severely impaired in G^(-)group and fungus group than in G^(+)group.In clinical practice,the changes of liver function in patients with sepsis should be closely detected,the severity of the disease should be evaluated in time,and a reasonable treatment plan should be formulated in time.