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目的研究严重急性呼吸综合征(SARS)合并肝损害的临床及病理学特征。方法在病程不同时期,动态观察60例SARS患者肝功能指标变化情况,比较SARS重症组病例与普通组病例的肝损害差异。结果76.7%患者ALT升高(146.3±118.3)u/L、40.0%患者AST升高(81.3±29.8)u/L,30.0%患者Bil升高(35.3±15.6)μmol/L;病程第2周肝损害最多见。SARS重症组ALT,AST和Bil异常升高率高于普通组,但仅AST差异有显著性。激素治疗组与非激素治疗组间肝功能异常发生率的差异并无显著性。约93.5%患者经常规保肝治疗3周后肝功复常。1例尸检显示肝脏广泛轻度非特异炎症反应。结论SARS病人合并肝脏损伤相当普遍,表现为转氨酶的轻中度升高,少部分病例伴有胆红素的轻度异常,适当保肝治疗是必须的,也是有效的。
Objective To study the clinical and pathological features of severe acute respiratory syndrome (SARS) associated with liver damage. Methods The changes of liver function indexes in 60 cases of SARS were observed dynamically at different stages of the course of disease. The difference of liver damage between SARS severe group and common group was compared. Results The ALT in the 76.7% patients was significantly higher than that in the controls (146.3 ± 118.3u / L, 81.3 ± 29.8u / L in 40.0% and 35.3 ± 15.6μmol / L in 30.0% The most common liver damage. The abnormal rates of ALT, AST and Bil in SARS severe group were higher than those in normal group, but there was only significant difference in AST. There was no significant difference in the incidence of abnormal liver function between hormone therapy group and non-hormone therapy group. About 93.5% of patients with regular liver protection after 3 weeks of liver function. An autopsy showed extensive mild non-specific inflammation in the liver. Conclusion SARS patients with liver injury is quite common, showing mild to moderate transaminase increased, in some cases with mild abnormalities of bilirubin, appropriate hepatoprotective treatment is necessary and effective.