58例严重脓毒血症患儿肝损伤的临床分析

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 U/L及〉400 U/L四组,各组的病死率依次为40.7%、47.6%、64.3%和...

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Published in临床肝胆病杂志 Vol. 32; no. 3; pp. 541 - 544
Main Author 彭慧云 李淼 周丽芳 覃小梅 范宸颖 李双杰
Format Journal Article
LanguageChinese
Published 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,长沙410007 2016
Subjects
低蛋白血症
国际标准化比
肝功能不全
脓毒症
liver insufficiency
hypoalbuminemia
肝功能不全
低蛋白血症
脓毒症
国际标准化比
international normalized ratio
sepsis
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ISSN1001-5256
DOI10.3969/j.issn.1001-5256.2016.03.031

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Summary: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 U/L及〉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%、44.1%、59.1%和93.3%,组间比较差异均有统计学意义（χ2=15.536,P〈0.01）;根据国际标准比值（INR）,分为有、无凝血功能障碍两组,其病死率分别为80.8%和41.7%,两组差异有统计学意义（χ2=12.147,P〈0.01）。存活组与死亡组间的ALT升高率,黄疸、低蛋白血症和凝血障碍发生率比较,差异均有统计学意义（P值均〈0.05）。结论肝损伤在儿童严重脓毒血症中发生率较高,ALT升高、黄疸、低蛋白血症和凝血功能障碍均与儿童严重脓毒血症的病死率具有明显相关性,对评估患儿的预后具有重要作用。
Bibliography:sepsis;liver insufficiency;hypoalbuminemia;international normalized ratio
PENG Huiyun,LI Miao,ZHOU Lifang,et al（Liver Disease Center, Hunan Children＇s Hospital, Changsha 410007, China）
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 in
ISSN:1001-5256
DOI:10.3969/j.issn.1001-5256.2016.03.031