250例SARS患者肝功能损害的临床分析

目的探讨严重急性呼吸综合征(SARS)患者肝功能损害的一般规律.方法收集250例确诊SARS患者病程第1～6周的肝功能结果,分析总结SARS病程中各指标的变化规律.结果PA在SARS病程的1,2周有明显下降(异常率分别为84%和64%),但很快恢复正常;TP和ALB在病程中均有一定比例的降低,A/G比值下降较明显(异常率均保持在50%以上).ALT病程第1周有52%的患者升高,第3周异常率达到87%,之后开始逐渐回落;AST的异常率及升高幅度均较ALT明显低(整个病程中异常率均＜50%).GGT在病程第3～5周有比较高的异常率(32%,40%和28%).CHE在病程第1周有29%的患者降低,第5周异常率达到46%,第6周开始稍有回升.TB,DB,TBA,ALP和LAP在整个病程中均无明显改变.结论SARS患者在病程早期即有明显的肝功能损害,且恢复较慢,提示在临床诊治过程中要注意护肝治疗.

Clinical characteristics and mechanism of liver function injury in 250 patients with severe acute respiratory syndrome

Objective: To summarize the clinical features of liver function injury in patients with severe acute respiratory syndrome (SARS). Methods: The laboratory data of 250 patients suffered from SARS were collected and analyzed, who were admitted to the isolation wards from 1 week to 6 week. The liver functions of all the patients were measured. Results: Prealbumin (PA) levels were obviously decreased in SARS patients within 2 week (abnormal ratio are 84%, 64%), and recover rapidly; Total protein (TP) and albumin (ALB) levels were lightly decreased during the hospitalization, albumin/globulin (A/G) ratio were obviously decreased (abnormal ratio are more than 50%). When being admitted 1 to 2 week, serum alanine aminotransferase (ALT) levels were elevated in 52% SARS patients in the first week, serum ALT levels were abnormal in 87% SARS patients in third week. Then, it begin decrease to normal level; the aspartate aminotransferase (AST) was not obviously increased in SARS patients compared with the ALT (abnormal ratio are not more than 50%). From third to fifth week, there are higher abnormal ratio on serum gamma-glutamyltransfease (GGT) levels were decreased in 29% SARS patients in the first week, serum ChE levels were abnormal in 46% SARS patients in fifth week. Then, it begin recover to normal level; the alkaline phosphatase (ALP), leucine aminopeptidase (LAP), total bilirubin (TB), direct bilirunbin (DB), total bile acid (TBA) in SARS patients normalized during the hospitalzation. Conclusions: There are the obvious liver damage in SARS patients in early stage, it suggests that timely measures should be taken to protect liver function.