脓毒症是否诱发急性肝功能障碍的危险因素及临床特征对比

目的 对比脓毒症诱发急性肝功能障碍的危险因素及相关临床特征.方法 将168例脓毒症患者按是否诱发急性肝功能障碍分为单纯脓毒症组（对照组,142例）和脓毒症诱发肝功能障碍组（观察组,26例）.比较两组生化指标、血浆内皮素（ET）-1、脓毒症相关的序贯器官衰竭评分（SOFA）等,并分析诱发急性肝功能障碍可能的危险因素.结果 168例脓毒症患者急性肝功能障碍发生率为15.5％ （26/168）.观察组总胆红素、直接胆红素、肌酐、血糖波动范围、动脉血乳酸、血浆ET-1、SOFA、病死率均明显高于对照组（35.9 ±9.8）μmol/L比（27.8 ±6.7） μμmol/L、（17.7±8.0）μμ mol/L比（12.3±5.9）μmol/L、（219.6±156.4） μmol/L比（159.4±125.3） μmol/L、（7.6±4.9）mmol/L比（3.0±1.6） mmol/L、（3.8±1.3） mmol/L比（2.0±1.2） mmol/L、（79.6±25.7） μg/L比（60.8±12.6） μμg/L、（8.8±2.6）分比（5.7±1.8）分、38.5％（10/26）比17.6％（25/142）],差异有统计学意义（P＜ 0.01或＜0.05）.多因素Logistic回归分析显示,长期饮酒、心功能不全以及低血压为脓毒症诱发急性肝功能障碍的独立危险因素.结论 脓毒症诱发急性肝功能障碍的患者具有较高的动脉血乳酸、血浆ET-1和SOFA,且长期饮酒、心功能不全以及低血压为危险因素.

Risk factors and clinical features on acute hepatic dysfunction induced by sepsis

Objective To study the risk factors and clinical features on acute hepatic dysfunction induced by sepsis.Methods One hundred and sixty-eight patients with sepsis were divided into 2 groups according to liver function：simple sepsis group （control group,142 cases） and acute hepatic dysfunction induced by sepsis group （observation group,26 cases）.The biochemical indicators,plasma endothelin （ET）-1,sepsis-related organ failure assessment （SOFA） were compared between 2 groups.The risk factors of inducing acute hepatic dysfunction were analyzed.Results The incidence of acute hepatic dysfunction in 168 patients with sepsis was 15.5% （26/168）.The total bilirubin,direct bilirubin,creatinine,range of blood glucose variation,arterial blood lactic acid,plasma ET-1,SOFA,fatality rate in observation group were significantly higher than those in control group （35.9 ±9.8） μμmol/L vs.（27.8 ±6.7） μmol/L,（17.7 ± 8.0） μ mol/L vs.（12.3 ± 5.9） μ mol/L,（219.6 ± 156.4） μ mol/L vs.（159.4 ± 125.3） μ mol/L,（7.6 ±4.9） mmol/L vs.（3.0 ± 1.6） mmol/L,（3.8 ± 1.3） mmol/L vs.（2.0 ± 1.2） mmol/L,（79.6 ±25.7）μg/L vs.（60.8 ± 12.6） μg/L,（8.8 ±2.6） scores vs.（5.7 ± 1.8） scores,38.5% （10/26） vs.17.6%（25/142）],there were statistical differences （P 〈 0.01 or 〈 0.05）.Multifactor Logistic regression analysis results showed that long-term drinking,cardiac insufficiency and hypotension were independent risk factors of acute hepatic dysfunction induced by sepsis.Conclusions The arterial blood lactic acid,plasma ET-1 and SOFA in patients with acute hepatic dysfunction induced by sepsis are higher.Long-term drinking,cardiac insufficiency and hypotension are the risk factors of acute hepatic dysfunction induced by sepsis.