对乙酰氨基酚剂量不能预测对乙酰氨基酚所致急性肝衰竭的预后。
Acetaminophen dose does not predict outcome in acetaminophen-induced acute liver failure.
作者信息
Gregory Blake, Larson Anne M, Reisch Joan, Lee William M
机构信息
University of Texas Southwestern Medical Center at Dallas, TX, USA.
出版信息
J Investig Med. 2010 Jun;58(5):707-10. doi: 10.231/JIM.0b013e3181db8764.
BACKGROUND
Acetaminophen is a dose-dependent toxin. Prognosis in severe acute liver injury is related presumably in part to the dose ingested. We sought to assess the value of acetaminophen dosing information in patients with acute liver failure (ALF) due to acetaminophen toxicity to determine the role of dose as a prognostic indicator.
METHODS
Prospective data from 113 patients with ALF having single-time-point ingestions of acetaminophen were analyzed. Multivariate and chi tests were used to determine the relationship of dose to clinical outcome. We also used the Mann-Whitney U test to compare prognosis and survival in ALF with acetaminophen dose ingested.
RESULTS
Multivariate and chi analyses failed to show any relationship between acetaminophen dose and spontaneous survival. A separate analysis showed no correlation between acetaminophen dose and clinical prognostic indicators.
CONCLUSIONS
Dose of acetaminophen ingested did not seem to play a role in prognosis. The most important prognostic factor was coma grade on admission to study. Acetaminophen dosing information is not always obtainable. When it is, it adds little to the clinical assessment. Severity of encephalopathy is a more reliable indicator of prognosis in these critically ill patients.
背景
对乙酰氨基酚是一种剂量依赖性毒素。严重急性肝损伤的预后可能部分与摄入剂量有关。我们试图评估对乙酰氨基酚剂量信息在因对乙酰氨基酚毒性导致急性肝衰竭（ALF）患者中的价值，以确定剂量作为预后指标的作用。
方法
分析了113例单次摄入对乙酰氨基酚的急性肝衰竭患者的前瞻性数据。采用多变量和卡方检验来确定剂量与临床结局的关系。我们还使用曼-惠特尼U检验来比较急性肝衰竭患者的预后和生存率与摄入的对乙酰氨基酚剂量。
结果
多变量和卡方分析未能显示对乙酰氨基酚剂量与自然生存之间的任何关系。单独分析显示对乙酰氨基酚剂量与临床预后指标之间无相关性。
结论
摄入的对乙酰氨基酚剂量似乎在预后中不起作用。最重要的预后因素是入组研究时的昏迷分级。对乙酰氨基酚剂量信息并非总是可获得的。即便可获得，它对临床评估的帮助也不大。在这些重症患者中，脑病严重程度是更可靠的预后指标。
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