严重急性呼吸综合征肝损伤的临床特征

The clinic characteristics and mechanism of liver damage in patients with severe acute respiratory syndrome

目的 了解严重急性呼吸综合征 (SARS)肝损伤的临床特征及其发生机制。方法 对 168例SARS患者住院期间肝功能和肝脏病理检查结果进行回顾性分析。结果 血清丙氨酸转氨酶 (ALT)异常率在入院时和住院第 1、2、3周分别占住院患者的 52 .5%、71.8% ,85.7%和 85.2 % ,ALT的均值分别是 56.0 7± 51.57、86.46± 69.93、10 6.69± 10 2 .50和 111.3 2± 160 .2 4;血清白蛋白 (Alb)平均值在入院时和住院第 1、2、3周分别是 3 7.2 5± 5.3 7、3 5.82± 4.74、3 4 .49± 5.0 4和 3 4 .2 6± 4.70 ;ALT异常的幅度与血氧饱和度下降和发热程度无显著相关 ;肝组织病理检查为非特异性炎性改变。结论 SARS患者肝损伤出现早、发生率高、持续时间较长 ,以血清白蛋白显著下降和ALT轻至中度增高为特征。低氧血症和发热不是导致肝损伤的直接原因 。

Objective To explore the clinic characteristics and mechanisms of liver damage in patients with severe acute respiratory syndrome. Methods The laboratory data of liver function and result of hepatic histological examination from 168 patients with SARS during hospitalization were retrospectively analyzed. Results In admission and the next three weeks, the abnormal rates of serum alanine aminotransferase (ALT)were shown as follows: 52.5%, 71.8%, 85.7%, 85.2%, and average level of ALT of patients was (56.07±51.57) μmol/L, (86.46±69.93) μmol/L, (106.69±102.50) μmol/L, (111.32±160.24) μmol/L respectively. At the same period, mean level of serum albumin was decreased apparently[(37.25±5.37) g/L, (35.82±4.74) g/L, (34.49±5.04) g/L, (34.26±4.70) g/L respectively]. Significant relativity did not be found between liver damage and blood oxygen saturation (SaO 2) or fever degree, hepatic histological examination showed the changes of non specific inflammation from 4 patients. Conclusions The liver damage of patients with SARS was appear in early stage, and the clinic features were decline of serum albumin obviously and mild or middling increased of ALT persistently. This hepatitis with SARS seems to be caused by SARS virus directly, and not by low SaO 2 or high fever.