影響肝衰竭患者血乳酸水平的相關因素分析
發(fā)布時間：2018-08-02 18:19
【摘要】：背景臨床上各種原因?qū)е聡乐馗尾〉母嗡ソ呋颊�，由于其肝功能異常，并發(fā)代謝紊亂，極易導致機體酸堿平衡失調(diào)，其中代謝性酸中毒是最易發(fā)生的酸堿失衡。代謝性酸中毒是導致機體多器官組織代謝紊亂，穩(wěn)態(tài)被打破，影響全身多臟器系統(tǒng)組織功能失調(diào)并衰竭的重要原因，嚴重影響疾病的轉(zhuǎn)歸。酸性產(chǎn)物包括乳酸、磷酸等原發(fā)性酸性物質(zhì)。其中乳酸堆積不僅預示著患者分解代謝增多，合成代謝減少，缺血缺氧，還表明肝功能的轉(zhuǎn)運、代謝功能下降，導致乳酸的循環(huán)再利用等受阻。乳酸堆積的嚴重程度加重，易誘發(fā)其惡性循環(huán)，進一步加重代謝紊亂。故臨床上對于肝衰竭的患者，其血乳酸值的高低已成為患者病情危重程度的重要客觀指標之一。我國大多數(shù)肝衰竭患者的基礎病因為乙型肝炎，服用核苷（酸）類似物抗病毒治療已成為其重要的治療措施之一。由于核苷（酸）類似物的機制主要是為抑制DNA多聚酶從而抑制病毒的復制，，從理論上也有可能抑制人體線粒體DNA的復制，會造成機體細胞的損傷。本研究將分析肝衰竭患者血乳酸水平變化與病人轉(zhuǎn)歸、性別、年齡、肝衰竭病因、是否使用核苷（酸）類似物抗病毒藥物等相關因素的關系，并探討其機制。 方法收集2011年1月-2011年10月間重慶醫(yī)科大學附屬第二醫(yī)院感染科收治的152符合肝衰竭診斷標準患者的臨床資料，分析其血乳酸水平與患者轉(zhuǎn)歸、年齡、性別、導致肝衰竭的基礎疾病、感染、抗病毒治療藥物以及相關并發(fā)癥等指標的關系及相關性。 結(jié)果患者血乳酸水平與患者性別、年齡、導致肝衰竭的病因、所使用的乙肝抗病毒藥物以及是否出現(xiàn)腹水情況等的組間比較無統(tǒng)計學意義（P＞0.05）；與患者轉(zhuǎn)歸、感染、PTA、肝性腦病、肝腎綜合征與血乳酸值有統(tǒng)計學意義（P＜0.05）。其中轉(zhuǎn)歸、PTA、肝性腦病P值為0.000，感染P值為0.023，肝腎綜合征P值為0.043。 結(jié)論綜合本研究結(jié)果，考慮影響肝衰竭患者血乳酸值升高的原因為疾病本身，感染及其相關并發(fā)癥加重血乳酸升高，提示病情嚴重程度的轉(zhuǎn)歸、PTA值亦與血乳酸值水平相關，但核苷（酸）類似物抗病毒對肝衰竭患者乳酸水平無明顯影響。 討論由研究得出肝衰竭患者血乳酸水平升高是由于疾病本身導致，已有多方研究觀察發(fā)現(xiàn)在肝衰竭早、中期，合理運用糖皮質(zhì)激素治療可有效阻止部分肝細胞壞死，降低病死率�，F(xiàn)今糖皮質(zhì)激素運用于肝衰竭的治療成為一個熱點話題。但其相關的副作用亦是大家顧忌的問題�！陡嗡ソ咴\療指南》中推薦肝衰竭早期，在無嚴重感染、出血等并發(fā)癥時可酌情使用。
[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.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R575.3
本文編號：2160297
[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.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R575.3
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