| 65 | 0 | 14 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 旨在探究脓毒症发生肝损伤的危险因素，为脓毒症肝损伤患者的诊疗提供参考。方法 回顾性分析402例脓毒症患者的临床数据，依据患者入住ICU期间急性肝损伤发生情况，将观察对象分为脓毒症肝损伤组与脓毒症非肝损伤组。通过单因素分析筛选与肝损伤发生潜在关联的临床指标，再构建多因素Logistic回归模型，确定影响脓毒症患者发生肝损伤的独立危险因素。结果 共收集符合标准的脓毒症患者229例，合并肝损伤患者110例（48.03%），其中肝损伤组死亡52例（47.27%）。脓毒症肝损伤组与脓毒症非肝损伤组分析比较：APACHEⅡ评分、SOFA评分、血小板、乳酸、纤维蛋白原含量、糖尿病、腹腔感染、血管活性药物治疗、CRRT治疗、机械通气治疗差异有统计学意义（P < 0.05）。纳入多因素Logistic中分析结果显示：SOFA评分（OR = 1.19， 95%CI: 1.06 ～ 1.33）、糖尿病（OR =3.27， 95%CI:1.65 ～ 6.48）、腹腔感染（OR =2.74， 95%CI:1.33 ～ 5.62）和机械通气（OR =5.24， 95%CI:1.58 ～ 17.41）为其独立危险因素。结论 糖尿病、腹腔感染、SOFA评分和机械通气治疗是脓毒症患者发生肝损伤的独立危险因素。
Abstract：Objective To explore the risk factors for liver injury in sepsis， so as to provide a reference for the diagnosis and treatment of sepsis patients with liver injury. Methods A retrospective analysis was conducted on the clinical data of 402 patients with sepsis. According to the occurrence of acute liver injury during ICU stay， the patients were divided into a sepsis with liver injury group and a sepsis without liver injury group. Univariate analysis was used to screen clinical indicators potentially associated with liver injury， and a multivariate Logistic regression model was then established to identify the independent risk factors for acute liver injury in sepsis patients. Results A total of 229 sepsis patients who met the inclusion criteria were enrolled， among whom 110 cases (48.03%) had liver injury， and 52 patients (47.27%) in the liver injury group died. There were statistically significant differences between the two groups in APACHE II score， SOFA score， platelet count， lactate level， fibrinogen content， diabetes mellitus， abdominal infection， vasoactive drug therapy， CRRT therapy， and mechanical ventilation therapy (P < 0.05). Multivariate Logistic regression analysis showed that SOFA score (OR = 1.19， 95%CI: 1.06 ～ 1.33)， diabetes mellitus (OR = 3.27， 95%CI: 1.65 ～ 6.48)， abdominal infection (OR = 2.74， 95%CI: 1.33 ～ 5.62)， and mechanical ventilation therapy (OR = 5.24， 95%CI: 1.58 ～ 17.41) were independent risk factors. Conclusion Diabetes， mellitus， abdominal infection， SOFA score， and mechanical ventilation therapy are independent risk factors for acute liver injury in sepsis patients.
[1] 余慧林， 王建丰， 刘 义， 等. TLR4/RhoA信号通路调控连续血液滤过治疗引起脓毒症内皮细胞通透性变化的机制[J]. 安徽医科大学学报， 2023， 58(7): 1159-64.
[2] Rudd K E， Johnson S C， Agesa K M， et al. Global， regional， and national sepsis incidence and mortality， 1990–2017: analysis for the Global Burden of Disease Study[J]. Lancet， 2020， 395(10219): 200-11. doi:10.1016/s0140-6736(19)32989-7.
[3] Fleischmann-Struzek C， Mellhammar L， Rose N， et al. Incidence and mortality of hospital- and ICU-treated sepsis: results from an updated and expanded systematic review and meta-analysis[J]. Intensive Care Med， 2020， 46(8): 1552-62. doi:10.1007/s00134-020-06151-x.
[4] 薛 娟， 杨 欣， 莫共柔， 等. 基于网络药理学和体内实验分析黄柏多糖治疗肝损伤的作用机制[J]. 安徽医科大学学报， 2024， 59(2): 267-74. doi:10.19405/j.cnki.issn1000-1492.2024.02.014.
[5] Sands K E. Epidemiology of sepsis syndrome in 8 academic medical centers[J]. JAMA， 1997， 278(3): 234. doi:10.1001/jama.1997.03550030074038.
[6] Sun J， Zhang J， Wang X， et al. Gut-liver crosstalk in sepsis-induced liver injury[J]. Crit Care， 2020， 24: 614. doi:10.1186/s13054-020-03327-1.
[7] Vincent J L， Angus D C， Artigas A， et al. Effects of drotrecogin Alfa (activated) on organ dysfunction in the PROWESS trial[J]. Crit Care Med， 2003， 31(3): 834-40. doi:10.1097/01.ccm.0000051515.56179.e1.
[8] Bakker J， Grover R， McLuckie A， et al. Administration of the nitric oxide synthase inhibitor NG-methyl-l-arginine hydrochloride (546C88) by intravenous infusion for up to 72 hours can promote the resolution of shock in patients with severe sepsis: results of a randomized， double-blind， placebo-controlled multicenter study (study No. 144-002)[J]. Crit Care Med， 2004， 32(1): 1-12. doi:10.1097/01.ccm.0000105118.66983.19.
[9] Shankar-Hari M， Phillips G S， Levy M L， et al. Developing a new definition and assessing new clinical criteria for septic shock: for the third international consensus definitions for sepsis and septic shock (sepsis-3)[J]. JAMA， 2016， 315(8): 775. doi:10.1001/jama.2016.0289.
[10] Chand N， Sanyal A J. Sepsis-induced cholestasis[J]. Hepatology， 2007， 45(1): 230-41. doi:10.1002/hep.21480.
[11] Yan J， Li S， Li S. The role of the liver in sepsis[J]. Int Rev Immunol， 2014， 33(6): 498-510. doi:10.3109/08830185.2014.889129.
[12] Promsin P， Grip J， Norberg ?， et al. Optimal cut-off for hourly lactate reduction in ICU-treated patients with septic shock[J]. Acta Anaesthesiol Scand， 2019， 63(7): 885-94. doi:10.1111/aas.13366.
[13] Wang D， Yin Y， Yao Y. Advances in sepsis-associated liver dysfunction[J]. Burns Trauma， 2014， 2(3): 97-105. doi:10.4103/2321-3868.132689.
[14] Bonnard C， Durand A， Peyrol S， et al. Mitochondrial dysfunction results from oxidative stress in the skeletal muscle of diet-induced insulin-resistant mice[J]. J Clin Invest， 2008， 118(2): 789-800. doi:10.1172/jci32601.
[15] Morino K. Reduced mitochondrial density and increased IRS-1 serine phosphorylation in muscle of insulin-resistant offspring of type 2 diabetic parents[J]. J Clin Investig， 2005， 115(12): 3587-93. doi:10.1172/jci25151.
[16] Brownlee M. The pathobiology of diabetic complications[J]. Diabetes， 2005， 54(6): 1615-25. doi:10.2337/diabetes.54.6.1615.
[17] Wong F， Piano S， Singh V， et al. Clinical features and evolution of bacterial infection-related acute-on-chronic liver failure[J]. J Hepatol， 2021， 74(2): 330-9. doi:10.1016/j.jhep.2020.07.046.
[18] Vincent J L， Moreno R， Takala J， et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure[J]. Intensive Care Med， 1996， 22(7): 707-10. doi:10.1007/BF01709751.
[19] Ferreira F L，Bota D P，Bross A，et al．Serial evaluation of the SOFA score to predict outcome in critically ill patients[J]．JAMA， 2001， 286(14): 1754-8. doi:10.1001/jama.286.14.1754.
[20] Brienza N， Dalfino L， Cinnella G， et al. Jaundice in critical illness: promoting factors of a concealed reality[J]. Intensive Care Med， 2006， 32(2): 267-74. doi:10.1007/s00134-005-0023-3.
[21] Johnson E E， Hedley-Whyte J， Hall S V. End-respiratory pressure ventilation and sulfobromophthalein sodium excretion in dogs[J]. J Appl Physiol， 1977， 43(4): 714-20. doi:10.1152/jappl.1977.43.4.714.
[22] Brienza N， Revelly J P， Ayuse T， et al. Effects of PEEP on liver arterial and venous blood flows[J]. Am J Respir Crit Care Med， 1995， 152(2): 504-10. doi:10.1164/ajrccm.152.2.7633699.
[23] Tr?ger K， Radermacher P， Georgieff M. PEEP and hepatic metabolic performance in septic shock[J]. Intensive Care Med， 1996， 22(11): 1274-5. doi:10.1007/BF01709351.
[24] Kiefer P， Nunes S， Kosonen P， et al. Effect of positive end-expiratory pressure on splanchnic perfusion in acute lung injury[J]. Intensive Care Med， 2000， 26(4): 376-83. doi:10.1007/s001340051170.
基本信息:
中图分类号:R459.7;R575
引用信息:
[1]许伦兵,季强,邵敏.脓毒症相关急性肝损伤的临床特点及高危因素[J].安徽医科大学学报().
基金信息:
国家自然科学基金项目（编号：82370605）
2026-05-14
2026-05-14
2026-05-14