Kanai Shinichiro, Honda Takayuki, Uehara Takeshi, Matsumoto Takehisa
Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
J Clin Lab Anal. 2008;22(1):66-9. doi: 10.1002/jcla.20205.
The purpose of this study was to evaluate liver function tests as potential indicators of bacteremia. We examined 156 patients with laboratory-confirmed bacteremia (bacteremia group) and 211 bacteremia-negative patients with bacterial infections (control group). The patients of the two groups had no underlying liver diseases. For patients in the bacteremia group, we analyzed liver function tests results obtained the day when the first positive blood culture was ordered. For those in the control group, the same data were obtained on the day when the first of multiple negative blood cultures was ordered. At t-test analyses, serum levels of gamma-glutamyl transpeptidase (gamma-GT) and alkaline phosphatase (ALP) were significantly higher, and those of albumin, total cholesterol, and cholinesterase were significantly lower in the bacteremia group than in the control group. Multivariate analyses found serum cholinesterase as an independent factor with adjusted odds ratio of 0.319 (per 65 U/L, standard deviation [SD] size). Serum level of C-reactive protein (CRP), on the other hand, showed no significant difference between the two groups. Serum levels of gamma-GT, ALP, albumin, total cholesterol, and cholinesterase more rapidly altered when various bacterial infections accompanied bacteremia. Therefore, they may be useful in detecting sepsis in its early stages.
本研究的目的是评估肝功能检查作为菌血症潜在指标的情况。我们检查了156例实验室确诊菌血症的患者(菌血症组)和211例细菌感染但菌血症阴性的患者(对照组)。两组患者均无潜在肝脏疾病。对于菌血症组的患者,我们分析了首次进行血培养阳性当天获得的肝功能检查结果。对于对照组的患者,在首次多次血培养阴性当天获得相同的数据。经t检验分析,菌血症组血清γ-谷氨酰转肽酶(γ-GT)和碱性磷酸酶(ALP)水平显著升高,而白蛋白、总胆固醇和胆碱酯酶水平显著低于对照组。多因素分析发现血清胆碱酯酶是一个独立因素,调整后的比值比为0.319(每65 U/L,标准差[SD]大小)。另一方面,两组间C反应蛋白(CRP)的血清水平无显著差异。当各种细菌感染伴有菌血症时,血清γ-GT、ALP水平、白蛋白、总胆固醇和胆碱酯酶水平变化更快。因此,它们可能有助于早期检测败血症。