SARS患者的肝脏损害

Study on the damage of liver in patients with SARS

目的 研究严重急性呼吸综合征 (SARS)患者肝脏功能和肝组织病理学的变化 ,探讨 SARS患者肝脏损害的可能机制及其临床意义。方法 依据中华人民共和国卫生部诊断标准 ,选择 2 0 0 3年 2— 6月收治的 SARS患者 110例检测肝脏功能 ,其中 8例死亡者行肝组织病理学检查 ;并与健康体检者 35例进行比较。结果 SARS组患者血清丙氨酸转氨酶 (AL T)、天冬氨酸转氨酶 (AST)、总胆红素 (TBil)、乳酸脱氢酶(L DH)水平均显著高于对照组 ,分别为 (91.6 1± 5 0 .5 3) U/ L 比 (32 .91± 10 .5 6 ) U/ L,(78.6 8± 33.32 ) U/ L 比(2 9.4 3± 8.89) U/ L,(11.6 7± 4 .2 6 ) μmol/ L 比 (8.4 4± 3.86 ) μmol/ L,(42 9.95± 188.94 ) U/ L 比 (2 0 0 .83±4 4 .86 ) U / L ,P均 <0 .0 0 1;白蛋白 (AL B)和前白蛋白 (PAB)均明显低于对照组 ,分别为 (34.4 0± 5 .13) g/ L比(42 .0 9± 6 .79) g/ L和 (0 .2 0± 0 .0 6 ) g/ L比 (0 .34± 0 .0 5 ) g/ L ,P均 <0 .0 0 1;血清直接胆红素 (DBil)、总胆汁酸 (TBA)、γ谷氨酰转肽酶 (GGT )、碱性磷酸酶 (AL P)水平与对照组无差异 (P均 >0 .0 5 )。 AL T、AST、GGT、L DH变化范围较大 ,为正常范围 4～ 9倍 ,其余各项变化范围较小。AL T、AST和 PAB异常率达 80 .0 %以上 。

Objective To study the changes in liver function and histopathology,and investigate the underlying mechanism and clinical significance of damage of liver in patients with severe acute respiratory syndrome (SARS). Methods According the clinical diagnostic standard of atypical pneumonia of Ministry of Health P. R. China,liver function was assessed in 110 SARS patients admitted from February 2003 to June 2003. Of them 8 SARS patients died,and the livers were pathologically examined,and their liver function parameters were compared with that of the 35 healthy controls. Results Alanine aminotransferase(ALT),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),total bilirubin(TBil) of patients with SARS were higher than those of controls,they were (91.61±50.53)U/L vs. (32.91±10.56)U/L, (78.68±33.32)U/L vs. (29.43±8.89)U/L,(429.95±188.94)U/L vs. (200.83±44.86)U/L,(11.67±4.26)μmol/L vs. (8.44±3.86)μmol/L,all P <0.001. Albumin(ALB) and proalbumin(PAB) of patients with SARS were lower than those of controls,they were (34.40±5.13)g/L vs. (42.09±6.79)g/L, (0.20±0.06)g/L vs. (0.34±0.05)g/L,both P <0.001. Direct reaction bilirubin(DBil),total bile acid(TBA),gammaglutamyltransferase(GGT) and alkaline phosphatase(ALP) showed no marked difference between SARS patients and controls,all P >0.05. Nonspecific inflammation in the liver was observed in pathological examination in 4 cases. ALT,AST,GGT and LDH were always 4 to 9 times of normal. The ratio of abnormity of ALT,AST and PAB were more than 80.0%, the ratio of abnormality of ALB was 42.7%,and less than 30.0% for other indexes. The average of LDH,ALT,AST of dead patients were higher than those of the survivors. Histopathology of liver was nonspecific hepatitis. Conclusion The patients with SARS are prone to have mild nonspecific hepatitis. It seldom causes the typical symptoms of hepatitis and it is easy to be ignored in clinic.