影响肝衰竭患者血乳酸水平的相关因素分析

发布时间：2018-08-02 18:19

【摘要】：背景临床上各种原因导致严重肝病的肝衰竭患者，由于其肝功能异常，并发代谢紊乱，极易导致机体酸碱平衡失调，其中代谢性酸中毒是最易发生的酸碱失衡。代谢性酸中毒是导致机体多器官组织代谢紊乱，稳态被打破，影响全身多脏器系统组织功能失调并衰竭的重要原因，严重影响疾病的转归。酸性产物包括乳酸、磷酸等原发性酸性物质。其中乳酸堆积不仅预示着患者分解代谢增多，合成代谢减少，缺血缺氧，还表明肝功能的转运、代谢功能下降，导致乳酸的循环再利用等受阻。乳酸堆积的严重程度加重，易诱发其恶性循环，进一步加重代谢紊乱。故临床上对于肝衰竭的患者，其血乳酸值的高低已成为患者病情危重程度的重要客观指标之一。我国大多数肝衰竭患者的基础病因为乙型肝炎，服用核苷（酸）类似物抗病毒治疗已成为其重要的治疗措施之一。由于核苷（酸）类似物的机制主要是为抑制DNA多聚酶从而抑制病毒的复制，，从理论上也有可能抑制人体线粒体DNA的复制，会造成机体细胞的损伤。本研究将分析肝衰竭患者血乳酸水平变化与病人转归、性别、年龄、肝衰竭病因、是否使用核苷（酸）类似物抗病毒药物等相关因素的关系，并探讨其机制。方法收集2011年1月-2011年10月间重庆医科大学附属第二医院感染科收治的152符合肝衰竭诊断标准患者的临床资料，分析其血乳酸水平与患者转归、年龄、性别、导致肝衰竭的基础疾病、感染、抗病毒治疗药物以及相关并发症等指标的关系及相关性。结果患者血乳酸水平与患者性别、年龄、导致肝衰竭的病因、所使用的乙肝抗病毒药物以及是否出现腹水情况等的组间比较无统计学意义（P＞0.05）；与患者转归、感染、PTA、肝性脑病、肝肾综合征与血乳酸值有统计学意义（P＜0.05）。其中转归、PTA、肝性脑病P值为0.000，感染P值为0.023，肝肾综合征P值为0.043。结论综合本研究结果，考虑影响肝衰竭患者血乳酸值升高的原因为疾病本身，感染及其相关并发症加重血乳酸升高，提示病情严重程度的转归、PTA值亦与血乳酸值水平相关，但核苷（酸）类似物抗病毒对肝衰竭患者乳酸水平无明显影响。讨论由研究得出肝衰竭患者血乳酸水平升高是由于疾病本身导致，已有多方研究观察发现在肝衰竭早、中期，合理运用糖皮质激素治疗可有效阻止部分肝细胞坏死，降低病死率。现今糖皮质激素运用于肝衰竭的治疗成为一个热点话题。但其相关的副作用亦是大家顾忌的问题。《肝衰竭诊疗指南》中推荐肝衰竭早期，在无严重感染、出血等并发症时可酌情使用。
[Abstract]:Background due to abnormal liver function and metabolic disorder, metabolic acid-base imbalance is easily caused in patients with severe liver failure due to various clinical reasons. Metabolic acidosis is the most common acid-base imbalance. Metabolic acidosis is an important reason that leads to the disorder of metabolism and the breakdown of homeostasis, which affects the dysfunction and failure of multiple organ system of the whole body, and seriously affects the outcome of the disease. Acid products include lactic acid, phosphoric acid and other primary acidic substances. The accumulation of lactic acid not only indicates the increase of catabolism, the decrease of synthetic metabolism, ischemia and hypoxia, but also indicates that the transport of liver function and the decline of metabolic function lead to the obstruction of the circulation and reuse of lactic acid. Lactic acid accumulation is serious, easy to induce its vicious circle, further aggravation metabolism disorder. Therefore, for patients with liver failure, the level of blood lactic acid has become one of the important objective indicators of the severity of the disease. Hepatitis B is the basic cause of most patients with liver failure in China. Antiviral therapy with nucleoside (acid) analogue has become one of the most important treatment measures. Because the mechanism of nucleoside (acid) analogues is mainly to inhibit the replication of virus by inhibiting DNA polymerase, it is theoretically possible to inhibit the replication of human mitochondrial DNA, which will result in cell damage. In this study, we analyzed the relationship between the changes of blood lactate level and the outcome, sex, age, etiology of liver failure and the use of nucleoside (acid) analogue antiviral drugs in patients with liver failure, and discussed its mechanism. Methods from January 2011 to October 2011, 152 patients who met the criteria for diagnosis of liver failure were collected from the infection Department of the second affiliated Hospital of Chongqing Medical University, and their blood lactate level and outcome, age and sex were analyzed. Relationship and correlation of underlying diseases, infections, antiviral drugs and related complications leading to liver failure. Results there was no significant difference between the blood lactic acid level and gender, age, the etiology of liver failure, the hepatitis B antiviral drugs used and the ascites (P > 0.05). There were significant differences in serum lactic acid and PTA, hepatic encephalopathy, hepatorenal syndrome and blood lactic acid (P < 0.05). The P value of hepatic encephalopathy, infection and hepatorenal syndrome were 0.000, 0.023 and 0.043 respectively. Conclusion the results of this study suggest that the cause of the increase of blood lactic acid value in patients with liver failure is the disease itself. Infection and its related complications aggravate the increase of blood lactic acid, suggesting that the PTA value of the severity of the disease is also related to the level of blood lactic acid. However, nucleoside (acid) analogue had no significant effect on lactate level in patients with liver failure. It is discussed that the increase of blood lactic acid level in patients with liver failure is due to the disease itself. Many studies have found that in the early and middle stages of liver failure, reasonable use of glucocorticoid can effectively prevent some liver cells from necrotizing. Reduce mortality. The use of glucocorticoids in the treatment of liver failure has become a hot topic. However, the related side effects are also a problem for everyone to worry about. Early liver failure is recommended in the guidelines for diagnosis and treatment of liver failure, which can be used as appropriate in the absence of severe infection, bleeding and other complications.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R575.3

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