肝功能状况对脓毒症病情严重程度及预后的影响

摘要

目的：分析肝功能状况对脓毒症病情严重程度及预后的影响，为脓毒症患者预后的早期判断提供参考依据。方法选取哈尔滨医科大学附属第一医院及哈尔滨市传染病医院2011年5月－2015年5月收治的185例脓毒症患者，按照其急性生理与慢性健康评分（ APACHE Ⅱ评分）分为低分组（＜15分）、中分组（15～20分）及高分组（＞20分），并按照其28 d预后分为存活组、病死组，比较各组患者肝功能状况，分析肝功能指标与APACHEⅡ评分的相关性。结果185例患者中，67例存活，118例病死，病死率63．8％。随着患者APACHEⅡ评分的增加，其年龄、ALT、AST、TBIL、TBA水平均显著上升，ALB、CHE均显著下降，差异有统计学意义（P＜0．05）。病死组年龄、女性比例、ALT、AST、TBIL、TBA、APACHE Ⅱ评分显著高于存活组，ALB、CHE显著低于存活组，差异有统计学意义（ P＜0．05）。 ALT、AST、TBIL、TBA与脓毒症患者APACHE Ⅱ评分呈显著正相关，ALB、CHE与患者APACHE Ⅱ评分呈显著负相关（P＜0．05）。 APACHE Ⅱ评分、肝功能障碍、年龄是影响脓毒症患者预后的独立危险因素（P＜0．05）。结论脓毒症患者早期肝功能障碍可增加病死率，密切检测肝功能变化有望及时评估患者病情严重程度、预测预后并指导合理治疗策略的制定。%Objective To investigate the influence of liver function on the severity and prognosis of sepsis, and to provide a reference for the early diagnosis of sepsis patients.Methods One hundred and eighty-five patients with sepsis were collected, who were treated in the First Affiliated Hospital of Harbin Medical University and Infectious Diseases Hospital of Harbin from May.2011 to May.2015.According to the APACHE Ⅱscore, all patients were divided into low score group (<15), middle score group (15~20) and higher score group (>20).And all patients were also di-vided into survival group and mortality group, according to results of prognosis after treatment 28 days.The correlation between liver function and PACHE Ⅱ score was analyzed.Results Among the 185 patients, 67 survived and 118 died, the mortality rate was 63.8%.With the increase of APACHE Ⅱ score, the age, ALT, AST, TBIL, TBA also showed a growth trend, but the CHE, ALB were significantly decreased, and the difference was statistically significant (P<0.05).In the mortality group, the age, female ratio, ALT, AST, TBIL, TBA, APACHE Ⅱ were higher than those in the survival group, but the CHE, ALB were lower than those in survival group, and the differences were statisti-cally significant ( P<0.05) .The levels of ALT, AST, TBIL, TBA were positively correlated with APACHE Ⅱscore, and the ALB, CHE were negatively correlated with APACHE Ⅱscore (P<0.05).APACHEⅡscore, liver dysfunc-tion and age were independent risk factors for the prognosis of sepsis ( P<0.05) .Conclusion Early liver dysfunction could independently increase the mortality of sepsis, close monitoring of liver function could help to prompt assessment the severity of the sepsis ,and be beneficial for forecasting the prognosis , treatment strategy.