巴基斯坦卡拉奇一家三级护理医院（南亚）登革热患者急性肝炎的严重程度及其结果。
Severity of acute hepatitis and its outcome in patients with dengue fever in a tertiary care hospital Karachi, Pakistan (South Asia).
机构信息
Department of Medicine Aga Khan University Hospital Karachi, Pakistan.
出版信息
BMC Gastroenterol. 2010 May 7;10:43. doi: 10.1186/1471-230X-10-43.
BACKGROUND
Liver injury due to dengue viral infection is not uncommon. Acute liver injury is a severe complicating factor in dengue, predisposing to life-threatening hemorrhage, Disseminated Intravascular Coagulation (DIC) and encephalopathy. Therefore we sought to determine the frequency of hepatitis in dengue infection and to compare the outcome (length of stay, in hospital mortality, complications) between patients of Dengue who have mild/moderate (ALT 23-300 IU/L) v/s severe acute hepatitis (ALT > 300 IU/L).
METHODS
A Cohort study of inpatients with dengue viral infection done at Aga Khan University Hospital Karachi. All patients (> or = 14 yrs age) admitted with diagnosis of Dengue Fever (DF), Dengue Hemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS) were included. Chi square test was used to compare categorical variables and fischer exact test where applicable. Survival analysis (Cox regression and log rank) for primary outcome was done. Student t test was used to compare continuous variables. A p value of less than or equal to 0.05 was taken as significant.
RESULTS
Six hundred and ninety nine patients were enrolled, including 87% (605) patients with DF and 13% (94) patients with DHF or DSS. Liver functions tests showed median ALT of 88.50 IU/L; IQR 43.25-188 IU/L, median AST of 174 IU/L; IQR 87-371.5 IU/L and median T.Bil of 0.8 mg/dl; IQR 0.6-1.3 mg/dl. Seventy one percent (496) had mild to moderate hepatitis and 15% (103) had severe hepatitis. Mean length of stay (LOS) in patients with mild/moderate hepatitis was 3.63 days v.s 4.3 days in those with severe hepatitis (P value 0.002). Overall mortality was 33.3% (n = 6) in mild/moderate hepatitis vs 66.7% (n = 12) in severe hepatitis group (p value < 0.001). Cox regression analysis also showed significantly higher mortality in severe hepatitis group (H.R (4.91; 95% CI 1.74-13.87 and P value 0.003) and in DHF/DSS (5.43; CI 1.86-15.84 and P value 0.002). There was a significant difference for the complications like Bleeding (P value < 0.001), Acute Renal failure (ARF) (P value 0.002), Acalculus cholecystitis (P value 0.04) and encephalopathy (P value 0.02) in mild/moderate and Severe hepatitis groups respectively.
CONCLUSION
Severe hepatitis (SGPT>300IU) in Dengue is associated with prolonged LOS, mortality, bleeding and RF.
背景
登革热病毒感染导致的肝损伤并不少见。急性肝损伤是登革热的严重并发症，易导致危及生命的出血、弥漫性血管内凝血（DIC）和脑病。因此，我们试图确定肝炎在登革热感染中的发生率，并比较轻度/中度（ALT 23-300IU/L）与重度急性肝炎（ALT>300IU/L）登革热患者的结局（住院时间、住院死亡率、并发症）。
方法
这是在卡拉奇阿迦汗大学医院进行的一项登革热病毒感染住院患者的队列研究。所有年龄≥14 岁、诊断为登革热（DF）、登革出血热（DHF）或登革休克综合征（DSS）的患者均被纳入研究。使用卡方检验比较分类变量，必要时使用 Fisher 确切检验。主要结局的生存分析（Cox 回归和对数秩检验）。使用学生 t 检验比较连续变量。P 值≤0.05 为有统计学意义。
结果
共纳入 699 例患者，其中 87%（605 例）为 DF 患者，13%（94 例）为 DHF 或 DSS 患者。肝功能检查显示，中位 ALT 为 88.50IU/L，IQR 为 43.25-188IU/L；中位 AST 为 174IU/L，IQR 为 87-371.5IU/L；中位总胆红素为 0.8mg/dl，IQR 为 0.6-1.3mg/dl。71%（496 例）患者为轻度至中度肝炎，15%（103 例）患者为重度肝炎。轻度/中度肝炎患者的平均住院时间为 3.63 天，重度肝炎患者为 4.3 天（P 值<0.001）。轻度/中度肝炎组的总死亡率为 33.3%（n=6），重度肝炎组为 66.7%（n=12）（P 值<0.001）。Cox 回归分析还显示，重度肝炎组的死亡率显著更高（HR 为 4.91，95%CI 为 1.74-13.87，P 值=0.003），DHF/DSS 组的死亡率也显著更高（HR 为 5.43，CI 为 1.86-15.84，P 值=0.002）。轻度/中度和重度肝炎组在并发症方面存在显著差异，如出血（P 值<0.001）、急性肾功能衰竭（ARF）（P 值=0.002）、无结石性胆囊炎（P 值=0.04）和脑病（P 值=0.02）。
结论
登革热中严重肝炎（SGPT>300IU/L）与延长住院时间、死亡率、出血和 RF 相关。
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