横纹肌溶解症致战创伤患者肌酸激酶与肝酶的关系。

Relationship between creatine kinase and liver enzymes in war wounded with rhabdomyolysis.

机构信息

Percy Military Teaching Hospital, Department of Anesthesiology and intensive care unit, 101 avenue Henri Barbusse, 92140 Clamart, France.

出版信息

Injury. 2022 Jan;53(1):166-170. doi: 10.1016/j.injury.2021.10.004. Epub 2021 Oct 16.

DOI:10.1016/j.injury.2021.10.004

PMID:34689987

Abstract

BACKGROUND

Rhabdomyolysis is a frequent complication in war wounded. Its complex pathophysiology suggests that it not only affects kidneys but also other organs such as the liver. The aim of this study was to evaluate the relationship between creatine kinase (CK) and liver enzymes in war wounded with rhabdomyolysis.

METHODS

War wounded admitted to the intensive care unit of Percy Military Hospital between 2009 and 2017 with a rhabdomyolysis (CK peak >1,000 U/L) were included. They were divided in two groups: mild (CK peak <10,000 U/L) and severe rhabdomyolysis (CK peak ≥10,000 U/L). Demographic characteristics, peaks in transaminases, alkaline phosphatase (ALP), bilirubin, and CK were recorded. Mann Whitney-U test and, Fisher's exact test were used as appropriate. A Pearson's correlation test was used to determine the correlation between CK and liver enzymes after a log-normal transformation of the data.

RESULTS

Fifty-one patients were included (31 in the mild and 20 in the severe rhabdomyolysis group). Patients in the severe rhabdomyolysis group were more likely victims of explosions (85% vs 39%, p = 0.003). The transaminases peak was significantly higher in the severe rhabdomyolysis group (median AST peak 398 (270-944) vs 91 (63-157) U/L, p <0.0001, and median ALT peak 106 (77-235) vs 45 (34-71) U/L, p<0.0001). Bilirubin and ALP were higher in the severe rhabdomyolysis group (39 (25-49) vs 14(11-23) U/L, p = 0.0031 and 84 (55-170) vs 52 (39-85) U/L, p = 0.0063, respectively). We found a significant positive linear correlation between CK and ALT (r = 0.73, p<0.0001), AST (r = 0.89, p<0.0001), ALP (r = 0.41, p = 0.0035), and bilirubin (r = 0.37, p = 0.0083).

CONCLUSION

We found a statistically significant positive correlation between CK and liver enzymes in rhabdomyolysis war wounded, indicating that hepatic damage occurs when rhabdomyolysis is severe and associated with elevated bilirubin and ALP. Further studies are needed to confirm this phenomenon and elucidate the pathophysiological mechanism.

LEVEL OF EVIDENCE

IV STUDY TYPE: Diagnostic.

摘要

背景

横纹肌溶解症是战伤的常见并发症。其复杂的病理生理学表明，它不仅影响肾脏，还影响其他器官，如肝脏。本研究的目的是评估患有横纹肌溶解症的战伤患者肌酸激酶（CK）与肝酶之间的关系。

方法

纳入 2009 年至 2017 年期间因横纹肌溶解症（CK 峰值>1000 U/L）入住珀西军事医院重症监护病房的战伤患者。他们被分为两组：轻度（CK 峰值<10000 U/L）和重度横纹肌溶解症（CK 峰值≥10000 U/L）。记录患者的人口统计学特征、转氨酶峰值、碱性磷酸酶（ALP）、胆红素和 CK。使用 Mann Whitney-U 检验和 Fisher 确切概率法进行分析。对数据进行对数正态转换后，使用 Pearson 相关检验确定 CK 与肝酶之间的相关性。

结果

共纳入 51 例患者（轻度组 31 例，重度组 20 例）。重度横纹肌溶解症组更可能是爆炸伤（85%比 39%，p=0.003）。重度横纹肌溶解症组的转氨酶峰值明显更高（AST 峰值中位数 398（270-944）比 91（63-157）U/L，p<0.0001，ALT 峰值中位数 106（77-235）比 45（34-71）U/L，p<0.0001）。重度横纹肌溶解症组的胆红素和 ALP 更高（39（25-49）比 14（11-23）U/L，p=0.0031 和 84（55-170）比 52（39-85）U/L，p=0.0063）。我们发现 CK 与 ALT（r=0.73，p<0.0001）、AST（r=0.89，p<0.0001）、ALP（r=0.41，p=0.0035）和胆红素（r=0.37，p=0.0083）之间存在显著正线性相关。