颅脑损伤后肝功能试验异常：肝胆超声是一种敏感的诊断工具吗？

Liver function test abnormalities after traumatic brain injury: is hepato-biliary ultrasound a sensitive diagnostic tool?

机构信息

Neuro-Critical Care Unit, Department of Anaesthesia, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.

出版信息

Br J Anaesth. 2014 Feb;112(2):298-303. doi: 10.1093/bja/aet305. Epub 2013 Sep 25.

DOI:10.1093/bja/aet305

PMID:24067331

Abstract

BACKGROUND

This study was to evaluate the usefulness of hepato-biliary ultrasound (HBUS) for the investigation of isolated liver function tests (LFTs) abnormalities.

METHODS

We retrospectively reviewed HBUS reports in traumatic brain injury (TBI) patients admitted to our tertiary neuro-critical care unit (NCCU; January 2005-June 2011). We included patients receiving an HBUS for isolated LFTs derangement, excluding pre-existing hepato-biliary diseases or trauma. We assessed the temporal profile of alanine aminotransferase (ALT), bilirubin (Bil), and alkaline phosphatase (ALP).

RESULTS

Of 511 patients, 58 received an HBUS. Of these, 47 were investigated for isolated LFTs derangement; HBUS always failed to identify a cause for these abnormalities. The HBUS was performed on day 18 (range 6-51) with the following mean values: 246 IU litre(-1) [ALT, 95% confidence interval (CI) 183-308], 24 μmol litre(-1) (Bil, 95% CI 8-40), and 329 IU litre(-1) (ALP, 95% CI 267-390); only ALT (72, 95% CI 36-107) and ALP (73, 95% CI 65-81) were deranged from admission values (both P<0.01). At NCCU discharge, both ALT (160, 95% CI 118-202) and ALP (300, 95% CI 240-360) were higher than at admission (P<0.01). Compared with HBUS-day value, only ALT improved by NCCU discharge (P<0.05), while both were recovering by hospital discharge (ALT 83, 95% CI 59-107; ALP 216, 95% CI 181-251; P<0.01). At hospital discharge, ALP remained higher than at admission (P<0.01).

CONCLUSIONS

In TBI patients, HBUS did not appear sensitive in detecting causes for isolated LFT abnormalities. Both ALT and ALP worsened and gradually recovered. Their abnormalities did not prevent NCCU discharge. ALP recovered more slowly than ALT. TBI and its complications, critical illness, and pharmacological strategies may explain the LFTs derangement.

摘要

背景

本研究旨在评估肝胆超声（HBUS）在检查孤立性肝功能试验（LFT）异常中的作用。

方法

我们回顾性分析了 2005 年 1 月至 2011 年 6 月期间入住我院神经重症监护病房（NCCU）的创伤性脑损伤（TBI）患者的 HBUS 报告。我们纳入了因孤立性 LFT 异常而接受 HBUS 检查的患者，排除了存在肝胆疾病或外伤的患者。我们评估了丙氨酸氨基转移酶（ALT）、胆红素（Bil）和碱性磷酸酶（ALP）的时间变化。

结果

在 511 例患者中，58 例行 HBUS。其中，47 例因孤立性 LFT 异常而接受检查，但 HBUS 始终未能确定这些异常的原因。HBUS 在第 18 天（范围 6-51 天）进行，以下是平均数值：246IU/L（ALT，95%置信区间[CI]为 183-308）、24μmol/L（Bil，95%CI 为 8-40）和 329IU/L（ALP，95%CI 为 267-390）；只有 ALT（72，95%CI 为 36-107）和 ALP（73，95%CI 为 65-81）与入院时的值有差异（均 P<0.01）。在 NCCU 出院时，ALT（160，95%CI 为 118-202）和 ALP（300，95%CI 为 240-360）均高于入院时（均 P<0.01）。与 HBUS 当日值相比，只有 ALT 在 NCCU 出院时有所改善（P<0.05），而在出院时均在恢复（ALT 83，95%CI 59-107；ALP 216，95%CI 181-251；均 P<0.01）。在出院时，ALP 仍高于入院时（P<0.01）。