Brooks G S, Zimbler A G, Bodenheimer H C, Burchard K W
Department of Surgery, Brown University, Providence, Rhode Island.
Am Surg. 1991 Oct;57(10):656-62.
The progression of changes in biochemical liver test results during moderate and severe sepsis (SS) was studied prospectively in 43 patients admitted to a surgical intensive care unit. Using predetermined criteria, severity of sepsis was assessed by physicians blinded to the liver test results. Linear regression analysis showed that bilirubin levels increased at a rate approximating 0.95 mg/dl/day in patients with SS, whereas alkaline phosphatase levels did not rise initially in these patients. Following peak hyperbilirubinemia, however, alkaline phosphatase levels increased at approximately 4 IU/L/day. In patients with moderate sepsis (MS), bilirubin levels increased slowly (approximately 0.4 mg/dl/day) but alkaline phosphatase levels increased rapidly (approximately 29 IU/L/day). Following peak hyperbilirubinemia, alkaline phosphatase levels did not change. These data define patterns of liver test abnormalities of clinical importance. Rapidly rising bilirubin levels with little change in alkaline phosphatase levels are associated with SS, whereas markedly elevated alkaline phosphatase levels may indicate MS or resolution of SS. In critically ill surgical patients subjected to many potential hepatic insults, recognition of liver dysfunction with these patterns should alert the clinician to the possibility of underlying sepsis.
对收入外科重症监护病房的43例患者进行了前瞻性研究，以观察中度和重度脓毒症（SS）期间肝脏生化检查结果的变化进程。采用预先设定的标准，由对肝脏检查结果不知情的医生评估脓毒症的严重程度。线性回归分析显示，SS患者的胆红素水平以约0.95mg/dl/天的速率升高，而这些患者的碱性磷酸酶水平最初并未升高。然而，在高胆红素血症达到峰值后，碱性磷酸酶水平以约4IU/L/天的速度升高。在中度脓毒症（MS）患者中，胆红素水平升高缓慢（约0.4mg/dl/天），但碱性磷酸酶水平迅速升高（约29IU/L/天）。在高胆红素血症达到峰值后，碱性磷酸酶水平没有变化。这些数据确定了具有临床重要性的肝脏检查异常模式。胆红素水平迅速升高而碱性磷酸酶水平变化不大与SS相关，而碱性磷酸酶水平显著升高可能表明MS或SS已缓解。在遭受多种潜在肝脏损伤的重症外科患者中，通过这些模式识别肝功能障碍应提醒临床医生注意潜在脓毒症的可能性。
