Tung Chun-Bin, Tung Chun-Fang, Yang Dar-Yu, Hu Wei-Hsiung, Hung Dong-Zong, Peng Yen-Chun, Chang Chi-Sen
Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
Hepatogastroenterology. 2005 Sep-Oct;52(65):1347-50.
BACKGROUND/AIMS: Jaundice resulting from severe bacterial infection is well known, particularly in pediatric literature. Extremely high levels of alkaline phosphatase (ALP) have rarely been emphasized as a manifestation of bacteremia in adults. The aim of this study was to evaluate the characteristics of extremely high levels of ALP in adult patients as a manifestation of bacteremia.
Extremely high levels of ALP were defined as being more than 1000 U/L. From April 1998 to May 1999, we retrospectively reviewed those patients' charts who had ALP above 1000 U/L. Sixteen patients that had bacteremia among 96 patients with extremely high levels of ALP at the emergency department of Taichung Veterans General Hospital were included in this study.
Sixteen patients had bacteremia with extremely high levels of ALP, including 9 patients with malignant biliary obstruction (MBO), and 7 patients without MBO. The ALP levels ranged from 1002 to 2061 (1430.13+/-353.84) U/L. Ten patients were male, and 6 were female. Their ages ranged from 19 to 83 (56.13+/-16.51) years. A variety of gram-negative, and gram-positive organisms were identified, and Escherichia coli was the most common pathogen. Among the seven patients of bacteremia without MBO, 5 patients had underlying diabetes mellitus as the predisposing factor for development of the bacteremia. The ages of the bacteremia patients with MBO were older than those of patients without MBO (66.3+/-10.1 us. 43.0+/-13.7 years, P=0.0025).
Bacteremia from a variety of organisms is a common cause for extreme elevation of ALP. Escherichia coli is the most common pathogen and presented more often in patients with MBO than those without MBO. In the setting o f extremely high levels of ALP as a manifestation of bacteremia, the patients with MBO are as common as those without MBO. We have demonstrated clinically that hepatic dysfunction during bacteremia may be manifested predominantly by extreme elevation of alkaline phosphatase with little abnormality in serum bilirubin.
背景/目的：严重细菌感染导致的黄疸众所周知，尤其是在儿科文献中。极高水平的碱性磷酸酶（ALP）作为成人菌血症的一种表现很少被强调。本研究的目的是评估成人患者中极高水平ALP作为菌血症表现的特征。
极高水平的ALP定义为超过1000 U/L。从1998年4月至1999年5月，我们回顾性地查阅了那些ALP高于1000 U/L患者的病历。台中荣民总医院急诊科96例ALP水平极高的患者中有16例发生菌血症，这些患者被纳入本研究。
16例患者发生菌血症且ALP水平极高，其中9例患有恶性胆道梗阻（MBO），7例没有MBO。ALP水平范围为1002至2061（1430.13±353.84）U/L。10例为男性，6例为女性。他们的年龄范围为19至83（56.13±16.51）岁。鉴定出多种革兰氏阴性菌和革兰氏阳性菌，大肠杆菌是最常见的病原体。在7例无MBO的菌血症患者中，5例有基础糖尿病作为菌血症发生的易感因素。有MBO的菌血症患者年龄比无MBO的患者大（66.3±10.1对43.0±13.7岁，P = 0.0025）。
多种生物体引起的菌血症是ALP极度升高的常见原因。大肠杆菌是最常见病原体，在有MBO的患者中比无MBO患者中更常见。在以极高水平ALP作为菌血症表现的情况下，有MBO的患者与无MBO的患者一样常见。我们已经在临床上证明，菌血症期间的肝功能障碍可能主要表现为碱性磷酸酶极度升高，而血清胆红素几乎没有异常。
