严重急性呼吸综合征病程中的血清酶变化规律

Serum Enzyme's Change Pattern in the Course of SARS

目的 探讨严重急性呼吸综合征 (SARS)病程中血清丙氨酸转氨酶 (ALT)、天冬氨酸转氨酶 (AST)、肌酸激酶 (CK)和乳酸脱氢酶 (LD)活性的变化规律。方法 对 2 0 0 3年 2月 2日至 5月 2 5日在广州市某医院住院治疗的临床资料完整的 1 2 5例SARS患者进行血清ALT、AST、CK和LD测定 ,分析ALT和AST在病程中的变化规律以及CK与发热、LD与肺损害之间的关系。结果 1 2 5例SARS患者 (39例重症病例、86例普通型病例 )血清ALT活性在病程第 1、2周开始升高 ,第 2周时重症、普通型患者的ALT升高率分别高达 87 2 %、82 6 % ,差异无显著性 (χ2 =0 0 1 2 ,P >0 0 5 ) ;第 4周后随病情好转开始缓慢下降 ,第 1 2周时患者ALT已基本恢复正常。SARS患者血清AST活性在病程第 1、2周开始升高 ,第 2周时重症、普通型患者的AST升高率分别为 6 6 7%、4 5 3% ,差异有显著性 (χ2 =4 885 ,P <0 0 5 ) ,第 4周开始下降 ,第 8周时基本恢复正常。重症患者和普通型患者在发热期的CK升高率分别为 5 1 3%和 5 2 3% ,退热后一周的CK升高率降至 2 6 %、2 3% ,前后比较差异均有显著性 (P均 <0 0 1 )。重症患者和普通型患者在出现肺损害时的LD升高率分别为 6 9 2 %和 5 9 3% ,与发病初期的升高率 (1 2 0 %、1 6 3% )比较差异均?

Objective To explore the changes of serum enzyme of ALT, AST, CK and LD in the course of SARS. Methods Serum ALT, AST, CK and LD were tested in 125 SARS patients hospitalized in Guangzhou No.1 People's Hospital from February 2 to May 25, 2003. Analyzed ALT, AST changes and the relationships between CK and fever and LD and lung damage respectively. Results Of the 125 SARS cases, including 39 severe cases and 86 ordinary cases, ALT and AST activities started to rise at the first and second week. 87 2% of severe cases and 82 6% of ordinary cases showed increased ALT activity in the second week ( χ 2 =0 012, P >0 05). 66 7% of severe cases and 45 3% of ordinary cases had increased AST in the second week ( χ 2 =4 885, P <0 05). As patients' condition improved, ALT activity started to decrease slowly from the 4th week and almost returned to normal at 12th week, AST activity decreased from the 4th week and returned to normal at 8th week. About 50% SARS patients showed increased CK in fever phase but only about 3% one week after the fever was gone. 59%-69% SARS cases with lung damages showed increased LD but only 12%-16% in early phase of the illness. Conclusion In SARS patients, ALT and AST activity had significant increased. CK increased in fever phase. LD increased in lung damage phase.