58例严重脓毒血症患儿肝损伤的临床分析

彭慧云; 李淼; 周丽芳; 覃小梅; 范宸颖; 李双杰

doi:10.3969/j.issn.1001-5256.2016.03.031

58例严重脓毒血症患儿肝损伤的临床分析

DOI: 10.3969/j.issn.1001-5256.2016.03.031

湖南省儿童医院肝病中心，南华大学儿科学院感染病学研究室

基金项目:

国家十二五重大科技支撑项目(2012BAI04B01)；

详细信息

中图分类号: R720.597
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出版历程
- 出版日期: 2016-03-20

Liver injury in children with severe sepsis: a clinical study of 58 patients

Liver Disease Center, Hunan Children′s Hospital

Research funding:

摘要

摘要:
目的探讨儿童严重脓毒血症性肝损伤的临床特征及其对严重脓毒血症患儿预后的意义。方法选取2013年11月-2015年5月湖南省儿童医院收治的严重脓毒血症且临床资料完整的病例,统计入院24 h内的临床特征及肝功能指标,分析肝功能指标与严重脓毒血症程度及预后的关系。计量资料组间比较采用非参数Mann-Whiteny U秩和检验,计数资料组间比较采用χ2检验。结果共入选110例病例,58例出现肝损伤,肝损伤发生率为52.7%（58/110）。根据ALT水平分为<80 U/L、≥80且<200 U/L、≥200且<400>400 U/L四组,各组的病死率依次为40.7%、47.6%、64.3%和81.3%,组间比较差异具有统计学意义（χ2=9.458,P<0.05）;根据总胆红素水平分为有黄疸组和无黄疸组,病死率分别为75.0%和44.2%,两组差异具有统计学意义（χ2=7.129,P<0.01）;根据血浆白蛋白水平分为>35 g/L、≤35且>30 g/L、<30且≥25 g/L和<25 g/L四组,各组的病死率分别为35.9...
- 脓毒症 /
- 肝功能不全 /
- 低蛋白血症 /
- 国际标准化比
Abstract:
Objective To investigate the clinical characteristics and prognostic value of liver injury in children with severe sepsis. Methods Children with severe sepsis who were admitted to our hospital and had complete clinical data from November 2013 to May 2015 were enrolled as subjects. Clinical characteristics and parameters of liver function were evaluated within 24 hours after admission to the hospital. The relationship of the parameters of liver function with the level and prognosis of severe sepsis was analyzed. Continuous data of the two groups were compared using the Mann- Whiteny U test and categorical data were copared using the χ2test. Results A total of 110 patients were enrolled as subjects. In these patients,52. 7%( 58 /110) had liver injury. According to the level of alanine aminotransferase( ALT),patients were divided into four groups that had ATL levels of < 80 IU / L,80- 200 IU / L,200- 400 IU / L,and > 400 IU / L,respectively. There were significant differences in mortality rate between the four groups( 40. 7%,47. 6%,64. 3%,and 81. 3%; χ2= 9. 458,P < 0. 05). Patients were divided into jaundice group and non- jaundice group based on the total bilirubin level. The jaundice group had a significantly higher mortality rate than the non- jaundice group( 75. 0% vs 44. 2%,χ2= 7. 129,P < 0. 01). According to the level of serum albumin,patients were divided into four groups that had levels of serum albumin of > 35 g / L,30- 35 g / L,25- 30 g / L,and < 25 g / L,respectively. There were significant differences in mortality rate between the four groups( 35. 9%,44. 1%,59. 1%,and 93. 3%; χ2= 15. 536,P <0. 01). According to the International Normalized Ratio,patients were divided into coagulopathy group and non- coagulopathy group. The mortality rate was significantly higher in the coagulopathy group than in the non- coagulopathy group( 80. 8% vs 41. 7%,χ2= 12. 147,P <0. 01). The survival group had significantly higher incidence rates of increased ALT level,jaundice,hypoproteinemia,and coagulopathy than the dead group( all P < 0. 05). Conclusion The incidence of liver injury is high in children with severe sepsis. The mortality rate in patients is significantly correlated with the increase in the ALT level,jaundice,hypoproteinemia,and coagulopathy,which play an important role in the prognosis of severe sepsis.
- sepsis /
- liver insufficiency /
- hypoalbuminemia /
- international normalized ratio

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参考文献(14)

[1]CHAND N,SANYAL AJ.The role of the liver in sepsis[J].Int Rev Immunol,2014,33(6):498-510.

[2]QIAN SY,LIU J.Relationship between serum albumin level and prognosis in children with sepsis,severe sepsis or septic shock[J].Chin J Pediatr,2012,50(3):184-187.(in Chinese)钱素云,刘娟.脓毒症/严重脓毒症/脓毒症休克患儿血清白蛋白水平与预后关系的研究[J].中华儿科杂志,2012,50(3):184-187.

[3]ZENG WM,MAO P,HUANG YB,et al.Analysis of prognostic factors in sepsis and value prognosis[J].Chin J TCM WM Crit Care,2015,22(2):118-122.(in Chinese)曾文美,毛璞,黄勇波,等.脓毒症预后影响因素分析及预后价值评估[J].中国中西医结合急救杂志,2015,22(2):118-122.

[4]DELLINGER RP,LEVY MM,RHODES A,et al.Surviving sepsis campaign:international guidelines for management of sevewe sepsis and septic shock,2012[J].Intensive Care Med,2013,39(2):165-228.

[5]WENG ZX,YU ZJ,LONG GQ,et al.Analysis on risk factors of acute hepatic dysfunction to sepsis patients[J].China Med Herald,2015,12(2):12-15.(in Chinese)翁志雄,余志金,龙国清,等.脓毒症患者并发急性肝功能障碍的危险因素分析[J].中国医药导报,2015,12(2):12-15.

[6]CUI JL,REN XS.Early hepatic dysfunction in sepsis[J].Lingnan J Emerg Med,2007,812(4):251-252.(in Chinese)崔金玲,任新生.脓毒症发生早期肝功能障碍的临床研究[J].岭南急诊医学杂志,2007,812(4):25l-252.

[7]GILROY RK,MAILLIARD ME,GOLLAN N.Gastrointestinal disorders of the critically ill:eholestasis of sepsis[J].Best Pract Res Clin Gastroenterol,2003,17(3):357-367.

[8]MA CX.Raise awareness of sepsis liver injury[J].Chin Crit Care Med,2013,4(25):198-200.(in Chinese)马春晓.应提高对脓毒症肝损伤的认识[J].中华危重症病急救医学,2013,4(25):198-200.

[9]MATSUOKA K,MISAKI N,SUMITOMO S.Preoperative hypoalbuminemia is a risk factor for late bronchopleural fistula after pneumonectomy[J].Ann Thorac Cardiovasc Surg,2010,16(6):401-405.

[10]TANNURI AC,SBRAGIA L,TANNURI U,et al.Evolution of critically ill patients with gastroschisis from three tertiary centers[J].Clinics(Sao Paulo),2011,66(1):17-20.

[11]ALLEN KS,SAWHENY E,KINASEWITZ GT.Anticoagulant modulation of inflammation in severe sepsis[J].World J Crit Care Med,2015,4(2):105-115.

[12] LAI M,OUYANG WX,LIU N,et al.Observation on the efficacy of astragaloside for the treatment of liver injury in sepsis and the impact on TNF-αand IL-6[J].J Clin Res,2014,31(10):1900-1903.(in Chinese)赖敏,欧阳文献,刘娜,等.黄芪甲甙对大鼠脓毒症肝损伤疗效及TNF-α、IL-6的影响[J].临床医学研究,2014,31(10):1900-1903.

[13]CHEN H,QIAO LW,ZHANG LF.Clinical study of clinical efficacy of shenfu injection on sepsis after liver injury[J].J Clin Exp Med,2013,12(11):835-838.(in Chinese)陈昊,乔丽渂,张莉芬,等.参附注射液对脓毒症肝损伤疗效的临床研究[J].临床和实验医学杂志,2013,12(11):835-838.

[14]LU GQ,LI RG.Clinical analysis on 56 Children with sepsis[J/CD].Chin J Exp Clin Infect Dis:Electronic Edition,2015,9(6):784-787.(in Chinese)卢光全,李儒贵.56例儿童脓毒症患者的临床分析[J/CD].中华实验和临床感染病杂志:电子版,2015,9(6):784-787.

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