A Drug-induced Hepatitis Patient with a Manifestation of Liver Occupying Lesions on Ultrasound B:Case Report and Literature Review

Drug-induced liver injury(DILI)is defined as injury to the liver caused by exposure to a drug or some drugs.The number of cases suffering from DILI has been increased.There are few clinical features specifically associated with DILI.The recognition and diagnosis of DILI is difficult.In this report,we have described a DILI case caused by herbal remedies.

Value of transient ultrasonic elastography for evaluating the liver fibrosis and liver function in patients with drug-induced liver injury

Objective: To study the value of transient ultrasonic elastography for evaluating the liver fibrosis and liver function in patients with drug-induced liver injury. Methods: A total of 68 patients with drug-induced liver injury who were treated in our hospital between January 2016 and May 2017 were selected as drug-induced liver injury group, and 50 healthy volunteers who received physical examination in our hospital during the same period were selected as normal control group. The liver transient ultrasonic elastography parameter Stiffness levels as well as serum liver fibrosis index and liver function index contents of two groups of subjects were detected. Pearson test was used to evaluate the correlation of Stiffness levels with liver fibrosis and liver function damage degree in patients with drug-induced liver injury. Results:Stiffness level in drug-induced liver injury group was higher than that in normal control group;serum liver fibrosis indexes HA, LN, CⅣ, PⅢNP and CG contents were higher than those of normal control group;serum liver function indexes ALT, AST, ALP, STB and γ-GT contents were higher than those of normal control group. Conclusion: Transient ultrasonic elastography parameter Stiffness levels increase in patients with drug-induced liver injury, and the specific levels are consistent with the liver fibrosis and liver function damage degree, and can be used as the objective means to evaluate the disease severity.

Efficacy of Jian’ganle(健肝乐) versus Hugan Pian(护肝片),Glucuronolactone and Reduced Glutathione in Prevention of Antituberculosis Drug-induced Liver Injury

Summary： Evidence-based medicine is advocated by WHO and adopted by developed countries for many years. In China, however, the selection of essential medicine and various medical insurance reimbursement schemes medicine is usually based on experts＇ experience of prescription practice which is under heavy critics resulting from the lack of related comparative efficacy and evidence-based research. The efficacy of Jian＇ganle in prevention of drug-induced liver injury （DILI） caused by antituberculotics was evaluated in this study by comparison with Hugan Pian, glucuronolactone and reduced glutathione. Evidence was provided for relevant sectors such as Ministry for Human Resources and Social Security of the People＇s Republic of China and National Health and Family Planning Commission of the Peo- ple＇s Republic of China to select and renew the Essential Medicine List （EML）, the new rural cooperative medical scheme in China （NRCMS） list or the reimbursement list of industrial injury insurance. A total of 189 patients with initial pulmonary tuberculosis were divided into four groups who took antituberculotics combined with Jian＇ganle, Hugan Pian, glucuronolactone and reduced glutathione respectively. Their liver function profile including alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin （TBIL）, direct bilirubin （DBIL）, total protein （TP）, albumin （A） and globulin （G） were detected at admission as baseline and after treatment. The Jian＇ganle group was compared with the three others by chi-square tests. In an aspect of maintaining bilirubin indexes normal, Jian＇ganle was more efficacious than glucuronolactone. And Jian＇ganle had a little more efficacy than reduced glutathione to maintain protein indexes normal as well. And the therapeutic regimen of antituberculotics combined with Jian＇ganle was the best in treating tuberculosis and preventing DILI at the same time. The study showed that among the four hepatinicas which demonstrated similar prevention of DILI caused by antituberculotics, Jian＇ganle has more advantages over the three others to some extent, which provides a reliable basis for health sectors to select and renew the EML, NRCMS List or the reimbursement list of industrial injury insurance.

Antituberculosis Drug-Induced Liver Injury: An Ignored Fact, Assessment of Frequency, Patterns, Severity and Risk Factors

Background/Aims: Antituberculosis drug-induced liver injury (TB DILI) is a frequent medical problem in Pakistan. Critical understanding of various aspects of TB DILI is not only important to manage liver injury but may also prevent unnecessary discontinuation of antituberculosis treatment. The study is aimed to determine the frequency, types, severity and patterns of TB DILI. Study further evaluates various risk factors of TB DILI. Materials and Methods: This is a prospective cohort study of two seventy-eight patients with the diagnosis of tuberculosis, where patients were followed during tuberculosis treatment. TB DILI was defined in accordance to international DILI expert working group. Results: Out of two seventy eight-patients, ninety-five (34.14%) had TB DILI. The most common pattern of TB DILI was hepatocellular (63.15%) followed by mixed (23.15%) and Cholestatic (13.68%). Most of the patients had mild DILI (43.15%) followed by moderate (30.52%), severe (20.01%) and very severe (5.26%). Age > 35 years, concomitant hepatotoxic drugs, extrapulmonary TB and malnutrition are important risk factors for TB DILI. Conclusion: All patterns of TB DILI with varying severity were present. Age > 35 years, malnutrition, extrapulmonary TB and concomitant use of hepatotoxic drugs were risk factors for TB DILI.

Enhanced recovery after surgery program in the patients undergoing hepatectomy for benign liver lesions

Background:Enhanced recovery after surgery(ERAS)has shown effectiveness in terms of reducing the hospital stay and cost.However,the benefit of ERAS in patients undergoing hepatectomy for benign liver lesions is still unclear.Methods:ERAS was implemented in our center since March 1st,2018.From September 2016 to Febru-ary 2018,109 patients were enrolled into the control group,and from March 2018 to June 2019,124 patients were enrolled into the ERAS group.All the indicators related to operation,liver functions,and postoperative outcomes were included in the analysis.Results:The clinicopathologic baselines were similar in these two groups.A significantly higher propor-tion of patients underwent laparoscopic surgery in the ERAS group.On the whole,intraoperative blood loss(100.00 mL vs.200.00 mL,P<0.001),blood transfusion(3.23%vs.10.09%,P=0.033),total bilirubin(17.10μmol/L vs.21.00μmol/L,P=0.041),D-dimer(2.08μg/mL vs.2.57μg/mL,P=0.031),postoperative hospital stay(5.00 d vs.6.00 d,P<0.001),and postoperative morbidity(16.13%vs.32.11%,P=0.008)were significantly shorter or less in the ERAS group than those in the control group.After stratified by operation methods,ERAS group showed significantly shorter postoperative hospital stay in both open and laparoscopic operation(both P<0.001).In patients underwent open surgery,ERAS group demonstrated significantly shorter operative duration(131.76±8.75 min vs.160.73±7.23 min,P=0.016),less intra-operative blood loss(200.00 mL vs.450.00 mL,P=0.008)and less postoperative morbidity(16.00%vs.44.44%,P=0.040).Conclusions:ERAS program may be safe and effective for the patients underwent hepatectomy,especially open surgery,for benign liver lesions.

Autoimmune liver diseases in systemic rheumatic diseases

Systemic rheumatic diseases(SRDs)are chronic,inflammatory,autoimmune disorders with the presence of autoantibodies that may affect any organ or system.Liver dysfunction in SRDs can be associated with prescribed drugs,viral hepatitis,alternative hepatic comorbidities and coexisting autoimmune liver diseases(AILDs),requiring an exclusion of secondary conditions before considering liver involvement.The patterns of overlap diseases depend predominantly on genetic determinants with common susceptible loci widely distributing in both disorders.In AILDs,it is important to identify the overlapping SRDs at an early stage since such a coexistence may influence the disease course and prognosis.Commonly co-occurring SRDs in AILDs are Sjögren syndrome(SS),rheumatoid arthritis(RA)or systemic lupus erythematosus(SLE)in autoimmune hepatitis(AIH),and SS,RA or systemic sclerosis in primary biliary cholangitis.Owing to different disease complications and therapies,it is imperative to differentiate between SLE liver involvement and SLE-AIH overlap disease.Therapeutic options can be personalized to control coexisting conditions of liver autoimmunity and rheumatic manifestations in AILD-SRD overlap diseases.The collaboration between hepatologists and rheumatologists can lead to significant advances in managing such a complex scenario.In this review,we provide a comprehensive overview on coexisting AILDs in different SRDs and the therapeutic approach in managing these overlap diseases.

依托考昔对急性痛风性关节炎患者关节病变及肝肾功能改善效果

目的:研究依托考昔对急性痛风性关节炎患者的关节病变和肝肾功能的影响。方法:选择我院2016年6月-2017年6月诊治的急性痛风性关节炎患者120例,随机分为对照组和观察组,各60例。对照组采用双氯芬酸钠75mg/d口服,观察组采用依托考昔60mg/d口服,必要时联合关节腔内注射皮质类固醇(复方倍他米松3.5mg+2%利多卡因0.5ml+生理盐水0.5ml),疗程为5天。比较治疗前和治疗后1天、3天、5天关节病变评分(包括疼痛、触痛、肿胀和皮肤红晕4项),血尿酸、血沉、C反应蛋白(CRP)和白细胞计数,肝功能(ALT水平),肾功能(血肌酐水平)以及不良反应。结果:治疗后观察组与对照组关节病变评分均逐渐降低,且观察组低于对照组,差异有统计学意义(P<0.05);治疗后5天观察组血尿酸、血沉、CRP水平和白细胞计数均明显低于对照组,差异有统计学意义(P<0.05);观察组与对照组肝肾功能水平和不良反应发生率比较均无差异(P>0.05)。结论:依托考昔治疗急性痛风性关节炎患者可明显改善关节病变,不增加肝肾功能损伤,有较好的应用安全性和有效性。

肝功异常川崎病患儿发生冠状动脉损伤直接危险因素分析

目的探讨肝功异常川崎病患儿发生冠状动脉损伤(CAL)的直接危险因素。方法选择2020年9月至2022年8月在青岛市妇女儿童医院就诊的96例川崎病患儿作为实验组,根据谷丙转氨酶(ALT,ALT>50U/L为肝功异常)分为肝功正常组50例和肝功异常组46例;选择58例同期同年龄段呼吸科肺炎患儿作为对照组。对3组患儿均进行C-反应蛋白(CRP)、D-二聚体(D-D)、高密度脂蛋白胆固醇(HDL-C)、N端脑钠肽前体(NT-proBNP)的检测;同时对实验组进行超声心动图检查,比较川崎病两组之间CAL发生的比率。结果实验组患儿CRP、D-D、NT-proBNP的水平均明显高于对照组,HDL-C明显低于对照组(Z/t=603.00、588.00、48.00、6.65,均P<0.05);肝功异常组患儿CRP、D-D、NT-proBNP的水平均明显高于肝功正常组,HDL-C明显低于肝功正常组(Z/t=682.50、408.00、487.00、3.13,均P<0.05);超声心动图结果显示肝功异常组CAL发生率明显高于肝功正常组(χ2=5.16,P<0.05)。CRP、D-D、NT-proBNP及HDL-C水平预测肝功异常川崎病患儿并发CAL的ROC曲线结果显示,AUC分别为0.70、0.71、0.72、0.73;最佳临界值分别为64.88mg/L、2.05mg/L、1148.62pg/mL、0.66mmol/L;灵敏度分别为0.54、0.70、0.63、0.74;特异性分别为0.88、0.82、0.80、0.72;4个指标联合检测的AUC为0.84,灵敏度为0.89,特异性为0.63。结论CRP、D-D、NT-proBNP升高,HDL-C降低与川崎病发生密切相关;上述4个指标的变化可作为预测肝功异常川崎病患儿并发CAL的直接危险因素,且联合检测可提高诊断及预测价值。

生化检验项目在肝硬化疾病诊断中的临床价值研究

目的 研究肝硬化疾病诊断中应用生化检验项目的价值。方法 选取2021年1月-2022年12月常熟市第五人民医院60例确诊为肝硬化疾病的患者(肝硬化组)与60例非肝硬化疾病患者(非肝硬化组)为研究对象,分别作为肝硬化组和非肝硬化组,比较两组肝功能指标、纤维病变情况及肝硬化分级患者纤维病变情况。结果肝硬化组胆碱酯酶(2 235.12±69.14)U/L、总蛋白(12.54±1.32)g/L低于非肝硬化组(8 320.12±87.15)U/L、(85.02±5.12)g/L,差异有统计学意义(t=423.697、106.181,P<0.05)。肝硬化组总胆红素、γ-谷氨酰转肽酶、天冬氨酸氨基转移酶、丙氨酸氨基转移酶水平高于非肝硬化组,差异有统计学意义(P<0.05)。肝硬化组Ⅲ型前胶原、层粘连蛋白、透明质酸水平均高于非肝硬化组,差异有统计学意义(P<0.05)。A级患者Ⅲ型前胶原、层黏连蛋白水平高于B级患者,且B级患者高于C级患者,差异有统计学意义(P<0.05)。A级患者透明质酸水平低于B级患者,且B级患者低于C级患者,差异有统计学意义(P<0.05)。结论 肝硬化疾病诊断中应用生化检验项目能够区分患者与非患者的肝功能状况,了解肝组织纤维病变状况,并可以将肝硬化患者精准分级,为肝硬化疾病诊断及治疗提供重要的检验支持。

水飞蓟宾胶囊联合常规治疗对酒精性肝病伴早期肝纤维化病变患者血清氧化损伤和肝功能的影响

目的:探讨水飞蓟宾胶囊联合常规治疗对酒精性肝病(ALD)伴早期肝纤维化病变患者血清氧化损伤和肝功能的影响。方法:选取2013年4月-2015年1月到我院就诊的ALD伴早期肝纤维化病变患者,按随机数字表法分为对照组和研究组,每组38例。对照组予以常规对症治疗措施[戒酒、口服肌苷片(0.4 g/次,每日2次)、补充维生素和微量元素等];研究组在对照组治疗基础上口服水飞蓟宾胶囊(70 mg/次,每日2次),持续治疗48周。比较两组患者临床疗效及不良反应发生率差异,记录治疗前、后血清氧化损伤指标[超氧化物歧化酶(SOD)、丙二醛(MDA)]、肝纤维化指标[层粘连蛋白(LN)、透明质酸(HA)、Ⅳ型胶原(Ⅳ-C)、Ⅲ型前胶原(PCⅢ)]及肝功能指标[血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)]变化情况。结果:治疗前两组患者基线资料比较差异无统计学意义(P>0.05)。治疗后,研究组患者总有效率明显高于对照组(P<0.05),两组患者不良反应发生率差异无统计学意义(P>0.05)。与治疗前比较,两组患者血清MDA水平、肝纤维化指标和肝功能指标水平均明显降低(P<0.05),SOD水平明显升高(P<0.05),其中研究组改善效果较对照组更明显(P<0.05)。结论:水飞蓟宾胶囊联合常规治疗可增强ALD伴早期肝纤维化病变患者的临床疗效,主要表现为改善氧化应激、调节肝功能、抑制肝纤维化病变进程。

肝硬化门脉高压性胃病血清胃蛋白酶原的变化及意义

目的测定肝硬化者血清PG的水平,探讨肝硬化发生胃粘膜病变时胃粘膜的功能状态。方法胃镜观察已确诊的51例肝硬化患者胃粘膜病变,快速尿素酶实验或碳13呼气实验明确幽门螺杆菌感染情况,肝功能进行Child-Pugh分级,乳胶增强免疫比浊法检测血清PG(PGⅠ、PGⅡ)浓度,得出PGⅠ/PGⅡ值(PGR),数据进行统计学分析。结果血清PGⅠ水平比较,肝硬化PHG组明显低于无PHG组及对照组,差异有统计学意义,PGⅡ、PGR差异无统计学意义。肝硬化幽门螺杆菌感染与无幽门螺杆菌感染两组间比较PGⅡ、PGR比较有差异。肝硬化肝功能分级组间及酒精性肝硬化与乙肝肝硬化比较血清PG水平均无明显差异。结论肝硬化合并PHG时血清PGⅠ水平明显降低,胃粘膜损伤可达固有层,分泌功能降低;幽门螺杆菌可以影响PGⅡ水平;血清PG水平与肝功能无明显关系;血清PG水平尤其PGⅠ在一定程度上可以反映肝硬化胃粘膜功能状态。

正肝方对黄曲霉毒素B_1诱发的肝癌前病变大鼠肝功能的影响

目的:观察正肝方对黄曲霉毒素(AFB1)诱发的肝癌前病变大鼠肝功能的影响。方法:Wistar大鼠100只随机分为4组:模型对照组30只,正肝方小剂量预防组30只、正肝方大剂量预防组30只、正常大鼠对照组10只。除正常对照组外,先后用AFB1和2-乙酰氨基芴(2-AAF)处理各组大鼠造模。正肝方大、小剂量预防组在造模期间,将不同浓度正肝方水剂(0.6g/ml,0.3g/ml)分别灌喂大鼠;模型对照组用无菌蒸馏水灌喂大鼠。8周后处死大鼠、采血,肝组织取材。采用酶动力学法测定大鼠血清ALT、AST、ALP、GGT活性,亚硝酸钠氧化法测定血清TBil,溴甲酚绿比色法测定Alb。结果:AFB1可导致大鼠血清ALT、AST、GGT、TBil水平显著升高,Alb水平下降。正肝方能有效降低AFB1导致的大鼠血清高ALT、AST、ALP、GGT、TBil水平。结论:AFB1可导致大鼠严重肝损伤,具有很强的肝毒性。正肝方具有抗AFB1导致的肝损伤,保护肝功能的作用。

复方甘草酸苷在耐多药肺结核患者抗结核治疗过程中的保肝作用临床观察

目的观察复方甘草酸苷在耐多药肺结核患者化疗过程中的保肝作用。方法将68例耐多药肺结核化疗中肝损害患者随机分为治疗组36例、对照组32例,治疗组加用复方甘草酸苷,对照组加用肝太乐和益肝灵,观察2组治疗前、后的保肝作用和不良反应等。结果保肝治疗1mo后,治疗组和对照组保肝作用总有效率分别为94.4%、62.5%,二者比较具有显著性差异(P<0.01),不良反应发生率比较无显著性差异(P>0.05)。结论复方甘草酸苷用于耐多药肺结核肝功能损害患者保肝疗效可靠,不良反应少。

COPD患者伴肺性缺氧与肝功能损害的相关性研究

目的探讨慢阻肺患者伴肺性缺氧与肝功能损害的相关性研究。方法测定患者周围白细胞计数、肝功能及动脉血气分析,各参数值的组间采用t检验,动脉血气值与肝功能检测结果间作相关性直线回归分析。结果COPD患者治疗后周围血白细胞、中性粒细胞计数和肝功能各参数值均有明显改善(P<0.01);患者治疗后PaO2比治疗前明显升高,PaCO2比治疗前明显下降(P<0.01);pH值、PaO2与ALT、AST结果显著负相关;PaCO2与ALT、AST结果显著正相关(P均<0.01)。结论COPD患者肺性缺氧或伴有二氧化碳潴留时合并酸中毒对肝脏功能损害明显加重;COPD患者给予抗感染、保肝、支持疗法等治疗后肺性缺氧控制,肝功能可恢复正常。

血清谷胱甘肽硫转移酶测定及其临床应用

以酶法测定了血清GST活力。该法缓冲液最适pH为7.2,以60℃5分种终止酶反应最好,底物的最适浓度为0.1mmol/L。50例正常参考值(x±s,IU/L):14.66±9.7,批内与批间试验CV值均小于5％。临床测定了37例急性肝炎、14例重型肝炎、23例慢性活动性肝炎、7例肝硬化、14例原发性肝癌结果(x±s,IU/L)为66.92±19.84、95.62±16.51、46.62±12.50、43.57±10.98、23.84±7.52,与正常对照组相比有显著性差异(P<0.01或P<0.05)。GST是一较特异的肝功指标,有助于肝实质损害的预后判断。

声脉冲辐射力弹性成像评估肝脏占位患者术前肝储备功能

目的探讨声脉冲辐射力成像(ARFI)技术测量肝脏占位患者肝实质硬度以评价术前肝储备功能的价值。方法应用超声弹性成像ARFI技术检测63例肝脏占位患者肝实质硬度值(LS),同时行吲哚氰绿(ICG)排泄试验,记录ICG血浆清除率(ICG-K)及ICG 15 min滞留率(ICGR15)数值,以及Child-Pugh(CP)评分所需的各项检查进行评分,将LS值与ICGR15、ICG-K和CP评分进行相关性分析。结果 1例患者ARFI技术未获得有效数值。LS与ICGR15呈显著正相关(r=0.789,P<0.01),与ICG-K呈显著负相关(r=-0.738,P<0.01),与CP评分呈显著正相关(r=0.929,P<0.01)。CP评分A、B、C级之间患者LS值差异具有统计学意义(P<0.01)。结论 ARFI成像技术快速、简便、无创,可以有效评估肝脏占位患者肝功能储备,具有一定的临床价值。

原发性肝癌病人腹腔镜肝叶切除术后并发胆漏的风险预测模型构建

目的构建原发性肝癌(PHC)病人腹腔镜肝叶切除术(LH)后并发胆漏的风险预测模型。方法前瞻性选取医院2016年1月~2021年1月收治的100例PHC病人作为研究对象,均收集基线资料,行LH治疗,记录病人术后胆漏发生情况,将病人分为胆漏组与未发生胆漏组,比较两组基线资料及手术相关变量,采用回归分析检验LH术后并发胆漏的风险因子,建立胆漏风险预测模型,采用Hosmer-Lemeshow拟合优度检验,并绘制ROC曲线,评价胆漏风险预测模型对LH术后并发胆漏的预测效能。结果 100例PHC病人LH术后共有11例发生胆漏,有89例未发生胆漏;初步比较胆漏组与未发生胆漏组基线资料及手术相关变量后,经单项Logistic回归分析结果显示,病灶直径、丙氨酸氨基转移酶、天冬氨酸氨基转移酶高、合并术前胆管炎、术中出血量多是LH术后胆漏发生的风险因子(OR>1,P<0.05);余肝体积高是LH术后胆漏发生的保护因子(OR<1,P<0.05);绘制ROC曲线发现,胆漏风险预测模型用于预测LH术后胆漏发生风险的AUC>0.80,有一定预测价值;在原有研究人群的基础上采用Bootstrap法重采样100次,获得内部验证人群,将建立的风险预测评分系统对内部验证人群病人进行风险评估,结果提示,Hosmer-Lemeshow拟合优度检验P>0.05,拟合无显著差异,拟合满意。结论 PHC病人LH术后并发胆漏受多个风险因子影响,根据多个风险因子构建风险预测模型,对预测术后胆漏发生风险有一定效能。

冠心病合并非酒精性脂肪肝患者冠状动脉病变特点分析

目的：观察冠心病（CHD）患者非酒精性脂肪肝（NAFLD）的发病率及冠状动脉病变特点。方法纳入2011年6月~2012年12月苏北人民医院经冠状动脉造影（CAG）确诊为CHD的患者158例作为冠心病组，另纳入CAG检查结果阴性者142例作为对照组，通过肝脏彩超结果及饮酒情况比较两组NAFLD发病率。将所有患者按照是否合并NAFLD分为NAFLD组（n=158）及非NAFLD组（n=142），观察NAFLD组及非NAFLD组间病变血管数以及血管狭窄程度有无差异，同时采用放射免疫法测定一氧化氮（NO）和硝酸还原酶法测定内皮素（ET）水平，比较两组NO和ET的水平差异。结果冠心病组NAFLD发病率明显高于正常组（58.2% vs.36.6%），NAFLD患者冠脉多支病变（41.8% vs.31.1%）和重度狭窄（24.7%vs.10.6%）及完全闭塞（19.0%vs.6.3%）的比例明显高于不合并NAFLD患者（P＜0.05）；与非NAFLD组相比，NAFLD组NO明显下降、ET明显升高（P＜0.05）。结论NAFLD对冠心病的诊断及病变程度有预测价值，其机制可能与影响内皮功能有关。

肿瘤坏死因子-α、内毒素、白细胞介素-6与重症颅脑损伤急性肝损伤的相关性研究

目的探讨肿瘤坏死因子-α（TNF-α）、内毒素（LPS）、白细胞介素-6（IL-6）在重症颅脑损伤急性肝损伤发生过程中的相关性。方法收集2009年1月～2012年6月在笔者医院急诊科就诊，创伤指数（TI）≥17分、格拉斯哥昏迷评分（GCS）≤10分，除外合并其他部位损伤及在急诊死亡的重症颅脑损伤患者65例，急诊救治的同时抽血检查谷丙转氨酶（A1月）、谷草转氨酶（AST）、TNF-α、LPS、IL-6，与正常对照组相比较，并对观察组病例的检验结果进行相关性分析。结果观察组肝功能检验结果：ALT279．43±41．35U／L，AST258．49±39．62U／L；损伤因子检验结果：TNF-α 39．93±18．88ng／ml，LPS479．38±91．48IU／L，IL-6469．61±73．66ng／ml。与对照组同类数据相比，差异均有统计学意义（P均〈0．001）。观察组ALT与TNF-α、LPS、IL-6比较，其相关系数（r）均〉0．8552，AST与TNF-α、LPS、IL-6比较，r均〉0．8574，差异均有统计学意义，均呈显著正相关。结论TNF-α、LPS、IL-6参与了重症颅脑损伤急性肝损伤的发生、发展。在急诊救治重症颅脑损伤时，早期的加强对TNF-α、LPS、IL-6的干预，则有可能减轻急性肝损伤的程度。

川崎病合并肝功能损害患儿的临床特点

目的探讨川崎病合并肝功能损害患儿的临床特点和预后。方法收集940例川崎病患儿的临床资料,根据肝功能指标分为肝功能正常组(n=583)和肝功能损害组(n=357),比较2组患儿性别、年龄、白细胞(WBC)计数、血小板(PLT)计数、C反应蛋白(CRP),红细胞沉降率(ESR)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST),γ-谷氨酰转移酶(GGT)、总胆红素、治疗前发热天数、住院天数、冠状动脉病变、静脉注射免疫球蛋白(IVIG)无反应等指标是否存在差异。结果2组比较,性别、年龄、WBC计数、ESR的差异无统计学意义(P>0.05)。肝功能损害组CRP、ALT、AST、GGT、总胆红素、住院天数、IVIG无反应和冠状动脉病变发生率高于肝功能正常组(P<0.05),PLT计数低于肝功能正常组(P<0.05),治疗前发热天数短于肝功能正常组(P<0.05)。多因素logistic回归分析发现,总胆红素升高是IVIG无反应的独立危险因素。结论川崎病合并肝功能损害较常见,肝功能损害患儿CRP水平更高,住院时间更长,更易出现IVIG无反应和冠状动脉病变。总胆红素升高是IVIG无反应的危险因素。