缺血性肝炎临床特点分析

发布时间：2018-05-16 01:06

本文选题：缺血性肝炎 + 血清转氨酶　；参考：《广西医科大学》2014年硕士论文

【摘要】：目的：了解缺血性肝炎(Ischemic hepatitis，IH)的临床特点并与急性乙型病毒性肝炎比较，，提高IH的诊断及鉴别诊断水平，降低IH的误诊率。方法：采用回顾性分析方法收集整理广西医科大学第一附属医院2013年1月-2014年1月期间的IH58例及2010-2012年期间急性乙型病毒性肝炎32例患者的住院资料，包括性别、年龄、住院时间、入院前全身基础病变情况、发病时临床表现、后期的并发症情况、住院期间治疗情况、预后情况及实验室检查指标。运用统计学方法分析IH的临床特征并与急性乙型病毒性肝炎进行比较。结果：58例IH的发病年龄范围为1-83岁，平均年龄(48.19士22.74)岁，年龄在45岁以上的有38例，占65.51%。男性44例，女性14例(男:女=3.1:1)。IH临床表现除了食欲减退、恶心、呕吐、乏力等症状及黄疸、肝肿大的体征，还伴随有低血压，呼吸困难，意识改变、少尿或无尿、水肿、颈静脉充盈等表现；肝功能各项指标的最高值与正常值上限的倍数关系为：丙氨酸氨基转移酶(ALT)：170倍，天门冬氨酸氨基转移酶(AST):441倍，胆红素(TBIL):10.5倍，碱性磷酸酶(ALP)：13倍，谷氨酰转肽酶(GGT)：14.5，乳酸脱氢酶(LDH)：86倍。伴有多器官功能障碍（MODS）的IH的患者死亡率与无MODS组的差异有统计学意义(P＜0.05)。将IH与急性乙型病毒性肝炎肝功能进行比较，两者TBIL、血清白蛋白（ALB）、血清胆碱酯酶（CHE）、ALP的差异有统计学意义（P＜0.05）。结论：IH主要在44岁以上的中老年人中发生；IH临床表现以原发基础疾病的临床表现为主，肝炎的表现不突出；其肝功能指标中血清转氨酶呈现速升速降的特点；IH多数死于原发疾病的加重，伴有MODSIH的患者死亡率高于无MODS的。IH与急性乙型病毒性肝炎比较，肝功能中TBIL、ALP升高不明显，ALB、CHE下降明显。
[Abstract]:Objective : To study the clinical characteristics of ischemic hepatitis ( IH ) and compare with acute viral hepatitis B , improve the diagnosis and differential diagnosis of IH , and reduce the misdiagnosis rate of IH .

Methods : A retrospective analysis method was used to collect the data from the first Affiliated Hospital of Guangxi Medical University from January 2013 to January 2014 , including sex , age , hospitalization time , general basal pathological changes before admission , clinical manifestation , late complications , treatment condition , prognosis and laboratory test indexes during hospitalization . The clinical characteristics of IH were analyzed by statistical method and compared with acute viral hepatitis B .

Results : The age of onset of IH was 1 - 83 years , the mean age ( 48.19 卤 22.74 ) years , the age was 38 cases over 45 years old , accounting for 65.51 % . There were 44 males and 14 females ( male : female = 3.1 : 1 ) . In addition to anorexia , nausea , vomiting , hypodynamia , etc . , the clinical manifestation of IH was accompanied by signs of low blood pressure , dyspnea , consciousness change , oliguria or no urine , edema , jugular vein filling , etc . ;
The relationship between the highest value of liver function indexes and the upper limit of normal value was as follows : alanine aminotransferase ( ALT ) : 170 times , aspartate aminotransferase ( AST ) : 441 times , bilirubin ( TBIL ) : 10.5 times , alkaline phosphatase ( ALP ) : 13 times , glutamyltransferase ( GGT ) : 14.5 , lactate dehydrogenase ( LDH ) : 86 times .

Conclusion : IH occurs mainly in middle - aged and old people over 44 years of age ;
The clinical manifestation of IH is the main clinical manifestation of primary disease , and the manifestation of hepatitis is not prominent .
the serum transaminase in the liver function index is characterized by rapid ascending and descending ;
Most of IH died of primary disease , and the mortality rate of patients with MODSIH was higher than that without MODS . In comparison with acute viral hepatitis B , the increase of TBIL and ALP in liver function was not significant , ALB and CHE decreased .

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.1

【参考文献】