脓毒症并发肝损伤患者临床特征及其危险因素分析

doi:10.3969/j.issn.1672-5069.2019.03.015

摘要/Abstract

摘要： 目的分析脓毒症患者并发肝损伤的影响因素,为其早期防治提供科学依据。方法 2013年1月~2017年12月收治的117例脓毒症患者,并发肝损伤58例,未并发肝损伤59例。采用Logistic回归分析脓毒症并发肝损伤的影响因素。结果在117例脓毒症患者中,原发感染灶主要为腹腔（48.7%）、呼吸系统（32.5%）、皮肤软组织（7.7%）、泌尿系统（6.0%）、血液系统（1.7%）、心血管系统（0.9%）、消化系统（0.9%）、中枢系统（0.9%）和纵膈（0.9%）;肝损伤患者年龄为（61.0±14.9）岁,显著大于未并发肝损伤患者的【（52.6±18.0）岁,P<0.01】,住ICU时间为【9（5,12）】d,显著长于未并发肝损伤患者的【4（4,10）d,P<0.01】,SOFA评分为（8.7±2.4）,显著大于无肝损伤患者的【（7.1±2.2）,P<0.01】,APACHE II 评分为（21.9±6.4）,显著大于无肝损伤患者的【（18.4±6.0）,P<0.01】;在58例肝损伤患者中,呈高胆红素型21例,高转氨酶型24例,混合型13例,不同型肝损伤患者血清C-反应蛋白水平差异具有统计学意义（P<0.05）,混合型病死率为53.8%,显著高于高胆红素型（9.6%）或高转氨酶型【（33.3%）,P<0.05】;多因素分析显示年龄和APACHE II评分为脓毒症患者发生肝损伤的独立危险因素。结论脓毒症患者年龄越大,APACHEII评分越高,发生肝损伤的可能性越大,而混合型肝损伤患者预后差,应加强防治。

关键词: 脓毒症, 肝损伤, 影响因素

Abstract: Objectiv To investigate the clinical features and risk factors of liver injuries in patients with sepsis. Methods A retrospective analysis was performed in 117 patients with sepsis between 2013 and 2017. Out of them,58 were complicated by liver injury. The Logistic regression analysis was applied to explore the risk factors for sepsis-associated liver injury. Results In this series,the primary infection foci included abdomen （48.7%）,respiratory system（32.5%）,skin（7.7%）,urinary system（6.0%）,blood （1.7%）,cardiovascular system （0.9%）,gut（0.9%）,central nervous system（0.9%） and mediastina （0.9%）;the age of patients with liver injuries was （61.0±14.9） yr,significantly older than 【（52.6±18.0）yr,P<0.01】 in patients without,ICU stay was 【9（5,12）】 d, much longer than 【4（4,10）d,P<0.01】,SOFA score was（8.7±2.4）,significantly higher than 【（7.1±2.2）,P<0.01】,and APACHE II score was（21.9±6.4）,significantly higher than 【（18.4±6.0）,P<0.01】 in patients without;out of 58 patients with liver injuries,it presented as hyperbilirubinemia in 21,elevated serum ALT levels in 24 and mixed in 13,serum C-reaction protein levels in patients with different types of liver injuries were statistically different（P<0.05）,and the mortality in patients with mixed liver injuries was 53.8%,much higher than 9.6% in with hyperbilirubinemia or 33.3% in with elevated serum ALT levels（P<0.05）;multivariate analysis showed than the age and APACHE II score were the independent risk factors for liver injuries in patients with sepsis. Conclusion The older the patient with sepsis and the higher the APACHEII score are,the more chance the likelihood of liver damage occur in patients with sepsis,which might take into consideration in clinical practice and deal with properly in time.

Key words: Liver injury, Sepsis, Risk factors

杜敏, 周敏, 纪宗淑, 刘海燕, 汤睿, 周亮, 高智. 脓毒症并发肝损伤患者临床特征及其危险因素分析[J]. 实用肝脏病杂志, 2019, 22(3): 369-372.

Du Min, Zhou Min, Ji Zongshu. Clinical features and risk factors of liver injuries in patients with sepsis[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(3): 369-372.

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