成人获得性风疹患者肝功能损害的病理及临床观察

目的 探讨成人获得性风疹患者肝功能损害的临床及病理学特点,为临床诊治及判断预后提供依据.方法 36例成人获得性风疹患者,分别于入院次日及以后每隔5～10 d抽取静脉血,全自动生化分析仪定量检测患者血清总胆红素、直接胆红素、ALT、AST、血清总蛋白和血清白蛋白等肝功能指标,对其并发肝功能损害情况进行了连续动态观察,并对其中2例典型病例进行了肝活组织病理检查.无肝功能损害患者与并发肝功能损害患者住院天数比较采用秩和检验.结果 成人获得性风疹患者并发肝功能损害发生率高达77.8%,但其肝功能损害多轻微,多以ALT和(或)AST升高为主,其中以退疹后的第6～10日肝功能损害发生率最高,达72.2%,且此时肝功能损害亦最明显.肝脏活组织病理学检查发现其肝脏组织结构完整,仅有肝脏组织轻微炎症改变,并发现其病毒包涵体.并发肝功能损害患者组平均住院18.2 d,与无并发肝功能损害患者组平均住院7.8 d比较,差异有统计学意义(u=3.596,P＜0.05).结论 近年成人获得性风疹患者并发肝功能损害发生率高,但其肝功能损害多轻微,多以ALT升高为主.但一旦出现AST异常或黄疸,说明肝功能损害较重,除积极治疗外,要严密观察,防止发生急性肝衰竭.如本病患者并发肝功能损害,则明显延长了病程及住院时间.

Clinical and pathological features of adult patients with acquired rubella

Objective To explore the clinical and pathological features ofliver injury in adults with acquired rubella. Methods Thirty-six adult patients with acquired rubella (AAR) were enrolled in this study,the liver functions were dynamically analyzed, liver biopsy was done in two patients. Results Liver injury was found in 77.8% of the 36 patients, with slight elevation of ALT and/or AST. The highest incidence and the most serious liver injury occurred in the period of 6-10d after vanishing of the rashes. Viral inclusion bodies were found in the liver specimen, with complete histological architecture but slight inflammation. The mean hospitalization days of AAR accompanied with liver injury and without liver injury were 18.2days, 7.8days,respectively (u = 3.596 ＞1.96, P ＜ 0.05). Conclusion High incidence of liver injury is observed in the adult patients with acquired rubella occurred in recent years, usually exhibited by mild liver injury with slight elevation of ALT. The elevation of AST or jaundice may indicate more serious liver injury, and these patients should be given active treatment to prevent acute liver failure. Liver injury may prolong the course of rubella patients.