Koch A, Streetz K, Tischendorf J, Trautwein C, Tacke F
Medizinische Klinik III, Gastroenterologie, Stoffwechselerkrankungen und Internistische Intensivmedizin, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52072, Aachen, Deutschland,
Med Klin Intensivmed Notfmed. 2013 Oct;108(7):599-608; quiz 609-10. doi: 10.1007/s00063-013-0287-2.
Abnormal liver biochemical and function tests are found in the majority of critically ill patients and are associated with increased mortality. Frequent causes for elevated liver function tests in the intensive care unit (ICU) are acute hepatic dysfunction due to acute hepatitis, acute liver failure (ALF), and drug-induced liver injury (DILI). Furthermore, exacerbations of pre-existing liver diseases (acute on chronic) and secondary liver injury during critical diseases such as sepsis, right heart failure, or cardiogenic shock, resulting in ischemic or hypoxic hepatitis, need to be considered. Elevated liver enzymes may also reflect a complication of ICU treatment measures like drug-related hepatotoxicity, secondary sclerosing cholangitis in critically ill patients (SC-CIP), or related to parenteral nutrition. Comprehensive diagnostic evaluation is essential to identify the underlying etiology of abnormal liver function tests and to initiate the appropriate therapeutic strategies.
大多数危重症患者存在肝脏生化和功能检查异常，且与死亡率增加相关。重症监护病房（ICU）中肝功能检查升高的常见原因包括急性肝炎、急性肝衰竭（ALF）和药物性肝损伤（DILI）导致的急性肝功能障碍。此外，还需考虑既往存在的肝脏疾病（慢性基础上的急性发作）的加重，以及脓毒症、右心衰竭或心源性休克等危重症期间导致缺血性或缺氧性肝炎的继发性肝损伤。肝酶升高也可能反映ICU治疗措施的并发症，如药物相关肝毒性、危重症患者的继发性硬化性胆管炎（SC-CIP）或与肠外营养相关的并发症。全面的诊断评估对于确定肝功能检查异常的潜在病因并启动适当的治疗策略至关重要。
