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目的 了解严重急性呼吸综合征 (SARS)肝损伤的临床特征及其发生机制。方法 对 168例SARS患者住院期间肝功能和肝脏病理检查结果进行回顾性分析。结果 血清丙氨酸转氨酶 (ALT)异常率在入院时和住院第 1、2、3周分别占住院患者的 52 .5%、71.8% ,85.7%和 85.2 % ,ALT的均值分别是 56.0 7± 51.57、86.46± 69.93、10 6.69± 10 2 .50和 111.3 2± 160 .2 4;血清白蛋白 (Alb)平均值在入院时和住院第 1、2、3周分别是 3 7.2 5± 5.3 7、3 5.82± 4.74、3 4 .49± 5.0 4和 3 4 .2 6± 4.70 ;ALT异常的幅度与血氧饱和度下降和发热程度无显著相关 ;肝组织病理检查为非特异性炎性改变。结论 SARS患者肝损伤出现早、发生率高、持续时间较长 ,以血清白蛋白显著下降和ALT轻至中度增高为特征。低氧血症和发热不是导致肝损伤的直接原因 ,肝损伤可能是SARS相关病毒直接作用的结果
Objective To investigate the clinical features and pathogenesis of severe acute respiratory syndrome (SARS) liver injury. Methods 168 patients with SARS during hospitalization for liver function and liver biopsy results were retrospectively analyzed. Results The abnormal rates of serum alanine aminotransferase (ALT) were 52.5%, 71.8%, 85.7% and 85.2% respectively at admission and at the first and second week of hospitalization, mean ALT was 56.0 7 ± 51.57, 86.46 ± 69.93, 10 6.69 ± 10 2.50 and 111.3 2 ± 160.24; mean serum albumin (Alb) at admission and 1, 2, 3 weeks after hospitalization were 3 7.2 5 ± 5.3 7 , 3 5.82 ± 4.74,3 4 .49 ± 5.0 4 and 34.26 ± 4.70 respectively. There was no significant correlation between the magnitude of ALT abnormality and the decline of blood oxygen saturation and the degree of fever. Liver histopathology was nonspecific inflammatory changes. Conclusions The incidence of liver injury in SARS patients is early and the incidence rate is high and lasts longer, characterized by a significant decrease of serum albumin and mild to moderate ALT. Hypoxemia and fever are not the direct causes of liver damage, and liver damage may be the result of a direct effect of the SARS-associated virus