严重急性呼吸综合征合并心脏、肝脏损害的临床分析

Heart and liver damages in severe acute respiratory syndrome

目的 :了解严重急性呼吸综合征 (severe acute respiratory syndrom e,SARS)发病过程中合并心脏和肝脏损害的情况。 方法 :对我院近期收治的 6 9例 SARS患者病程中出现的与心脏、肝脏功能有关的临床表现、心电图及实验室检查结果进行分析。 结果 :6 9例患者中有 4 8例 (6 9.5 7% )出现心脏损害 ,4 2例 (6 0 .87% )出现肝脏损害 ,多数症状较轻 ;生化检查表现为心肌酶谱及肝功能指标异常 ;大部分患者有心电图改变 ,以窦性心动过速为主 ,部分有房性期前收缩和 ST- T变化。经一般治疗预后较好。死亡 7例 ,均死于呼吸衰竭或多器官功能衰竭 ;其中 1例尸检 ,光镜及电镜下均见肝脏和心脏的病理损害表现。结论 :SARS病程中合并心脏、肝脏损害较多见 ,这种损伤可能主要是病原本身所致 。

Objective:To study the heart and liver damages of severe acute respiratory syndrome(SARS) patients. Methods:The clinical manifestations,electrocardiogram and laboratory data of the heart and liver were analyzed in 69 SARS cases. Results:Among 69 cases,48(69.57%) showed heart damages and 42 (60.87%) liver damages,but most of them only had mild symptoms. Parameters of liver functions and myocardial enzymes were:ALT (131.82±97.51) U/L,AST (79.90± 37.17) U/L,TBIL (38.28±20.37) μmol/L,LDH (505.30±226.24) U/L,HBDH (399.00±175.19) U/L,CK (631.40± 384.40) U/L,CK MB (42.50±24.45) U/L.Abnormalities of electrocardiogram were found in most patients,mainly with sinus tachycardia,some with atrial premature beat and changes in ST T wave.Treatment was effective in most cases,and there were 7 deaths due to respiratory failure or multi organ dysfunction.Autopsy of 1 case showed heart and liver damages under light and electron microscope.Conclusion:The damages of heart and liver in SARS patients are very common,which are mainly caused by etiology of SARS and enhanced by hypoxia and side effect of medicines.