摘要
目的探讨儿童脓毒症相关性肝损伤的发病率、临床特征以及影响预后的危险因素。方法对上海市儿童医院PICU2011年1月至2015年12月收治的脓毒症合并肝损伤患儿的资料进行总结，Logistic回归分析筛选出影响患儿预后的危险因素。结果PICU脓毒症相关性肝损伤的发生率为9．7％（120／1242），病死率35．8％（43／120）。原发感染部位主要为呼吸道感染（50．0％）、腹腔感染（33．3％）和中枢神经系统感染（6．7％）。病原检测结果依次为革兰阴性菌58例（51．3％）、病毒30例（26．5％）、革兰阳性菌20例（17．7％）。肝功能障碍特征依次为谷丙转氨酶升高117例（97．5％）、凝血酶原时间（町）延长93例（77．5％）、白蛋白下降83例（69．2％）和总胆红素（totalbilirubin，TBIL）升高（〉17．1μmol／L）70例（58．3％）。单因素分析显示，死亡组患儿的TBIL、PT、活化部分凝血活酶时间、总胆汁酸明显高于存活组。Logistic回归分析示TBIL升高是影响预后的独立危险因素（OR=2．937，95％CI1．179—7．315，P=0．021），受试者工作特征曲线下面积为0．736；TBIL=64．5μmol／L是判断脓毒症相关性肝损伤患者预后的最佳截点，敏感度57．7％，特异度84．8％。结论儿童脓毒症相关性肝损伤发病率高，革兰阴性杆菌感染是其主要病原菌；肝功能损害主要表现为谷丙转氨酶升高、盯延长、白蛋白下降及高胆红素血症，高胆红素血症是影响预后的独立危险因素。
Objective To discuss the incidence, clinical characteristics of sepsis-associated liver injure in pediatric patients and risk factors that may affect the prognosis. Methods A retrospective analysis was made on the data of patients with sepsis-associated liver injure that had been hospitalized in Shanghai Children＇s Hospital from January 2011 to December 2015. The cases were divided into the survival group and the death group. Logistic regression analysis was made to screen out risk factors of patients with sepsis-associated liver injure that influence the prognosis. Results The incidence of sepsis associated liver dysfunction was 9. 7% （120/1 242） ,the mortality rate was 35.8% （43/120）. The most common focus of infection was respiratory tract infection （ 50. 0% ）, followed by abdominal cavity infection （ 33.3% ） and central nervous system infection （ 6. 7% ）. The pathogenic microorganisms were mainly gram-negative bacilli （ 51.3% ）, followed by virus （ 26. 5% ） and gram-positive bacterium （ 17.7% ）. The main manifestations of the liver injure were elevated ghitamic-pyruvic transaminase （ 117 cases, 97.5 % ）, prolonged prothrombin time （ PT ） （93 cases ,77.5% ） ,hypoproteinemia（ 83 cases ,69. 2% ） and hyperbilirubinemia（70 cases ,58.3% ）. The to- tal bilirubin （ TBIL）, PT, activated partial thromboplastin time and total bile acid of the death group were higher than thoes of the survival group. Logistic regression analysis indicated that elevated TBIL （ OR = 2. 937,95% CI 1. 179-7. 315 ,P =0. 021 ） was the independent risk factor for death. The area under receiver operating characteristic curve for TBIL （cut off was 64. 5 ~LmOI/L） was 0. 736 with sensitivity 57.7% and specificity 84. 8%. Conclusion The incidence rate of sepsis-associated liver injure among pediatric patient is high. Gram-negative bacilli are the main pathogenic microorganisms. This disease is manifested as the elevat- ed glutamic-pyruvic transaminase, hypoproteinemia, prolonged PT and hyperbilirubinemia. Hyperbilirubinemia is the independent risk factor that influences the prognosis.
作者
单怡俊
王春霞
崔云
张育才
Shan Yijun Wang Chunxia Cui Yun Zhang Yucai(Department of Critical Care Medicine,Shanghai Children＇s Hospital, Shanghai Jiaotong University, Shanghai 200040, Chin)
出处
《中国小儿急救医学》
CAS
2017年第5期346-350,共5页
Chinese Pediatric Emergency Medicine
基金
上海市科委西医科技引导类项目（16411970300）
关键词
脓毒症
总胆红素
脓毒症相关性肝损伤
重症监护病房
儿童
Sepsis
Total Bilirubin
Sepsis-associatad liver injure
Pediatric intensive care unit
Children
