Birrer Richard, Takuda Yasuharu, Takara Tsuyoshi
Medicine, St. Joseph's University Medical Center, USA.
Intern Med. 2007;46(14):1063-70. doi: 10.2169/internalmedicine.46.0059. Epub 2007 Jul 17.
Dramatic transient elevation in serum concentrations of hepatic enzymes occurs in some patients following a hypo-perfusion state. This entity is variously termed "shock liver" or "ischemic hepatitis", since the pathogenesis is considered to be ischemia. However, hypotension or shock is not always present.
We analyzed the medical records of 293 patients (322 episodes) who had a hypoxic state and were admitted to the critical care units of two general hospitals over a 13-year period.
Hepatic injury was identified in about 1% of patients in critical care admissions. In addition to hypotension, the causes for hepatic injury were a low flow state secondary to congestive heart failure and hypoxia from sepsis or respiratory failure and hypoxemia from a variety of etiologies. These values were mostly normalized within several days when the hypoxic etiology was corrected and a serious co-morbid state did not intervene.
Marked elevation of hepatic enzymes can be identified not only in patients with hypotension, but also in normotensive patients in hypoxic state. Thus, the condition is appropriately termed hypoxic hepatopathy.
部分患者在低灌注状态后会出现血清肝酶浓度急剧短暂升高。由于发病机制被认为是缺血，这种情况有多种称谓，如“休克肝”或“缺血性肝炎”。然而，低血压或休克并非总是存在。
我们分析了293例患者（322次发病）的病历，这些患者处于缺氧状态，在13年期间入住两家综合医院的重症监护病房。
在重症监护病房收治的患者中，约1%被发现有肝损伤。除低血压外，肝损伤的原因还包括继发于充血性心力衰竭的低流量状态、败血症或呼吸衰竭导致的缺氧以及各种病因引起的低氧血症。当缺氧病因得到纠正且无严重合并症干预时，这些指标大多在数天内恢复正常。
肝酶显著升高不仅可在低血压患者中发现，也可在缺氧状态的血压正常患者中发现。因此，这种情况被恰当地称为缺氧性肝病。
