热带病与寄生虫学

热带病与寄生虫学 ›› 2013, Vol. 11 ›› Issue (3): 137-138.doi: 10.3969/j.issn.1672-2302.2013.03.005

• 论著 • 上一篇    下一篇

钩端螺旋体病并发肝功能损害12 例临床分析

杨晴 吴春晓 喻婷婷 李林芳 宋玲英   

  1. 珠海市人民医院感染科
  • 出版日期:2013-09-10 发布日期:2013-11-18

Clinical analysis of 12 cases of leptospirosis complicated with liver dysfunction

Yang Qing, Wu Chuniao, Yu Tingting, Li Linfang, Song Lingying   

  1. Department of Infectious diseases, Zhuhai Municipal People’s Hospital
  • Online:2013-09-10 Published:2013-11-18

被引次数

2

摘要： 目的 回顾性分析钩端螺旋体病并发肝功能损害的临床特点。 方法 收集2010年4月～2013年3月珠海市人民医院收治的临床资料完整且并发肝功能损害的12例钩端螺旋体病患者资料进行分析。 结果 12例均有肝功能损害，占100%，有消化道症状如乏力纳差尿黄及恶心呕吐者8例。血清ALT及AST均升高12例，其中ALT及AST均高于1 000U/ml者4例，占1/3；血清TBil升高5例，占41.7%，TBil大于171µmol/ml者3例，占25.0%；PT延长者6例，PTA低于40%者3例，Alb降低7例，影像检查肝脏肿大3例、脾脏肿大1例，有腹腔积液者3例。经抗感染及护肝治疗8例患者痊愈，1例死亡，3例自动出院。 结论 肝功能损害在钩端螺旋体病发展过程中较普遍出现。多数患者肝功能损害于短期内好转，少数患者呈进行性发展，肝血清酶指标急剧升高，黄疸程度深，合并凝血功能障碍，需与重型病毒性肝炎相鉴别。重症钩体病者易发展到肝功能衰竭甚至多脏器功能衰竭。对不明原因发热伴肝功能损害的患者，临床应考虑钩端螺旋体病的可能，及时进行特异性抗体检测。

关键词: 钩端螺旋体病, 肝功能损害, 临床特点

Abstract: Objective  To analyze the clinical characteristics of leptospirosis complicated with liver dysfunction retrospectively.  Methods  From April of 2010 to March of 2013,12 cases of leptospirosis complicated with liver dysfunction which had holonomic information were collected and analyzed.  Results  All cases had liver dysfunction and 66.7% had gastrointestinal manifestations (8/12). The level of ALT and AST all increased in the cases and 4 cases were more than U/ml. 5 cases (41.7%) had higher level of TBil, of which 3 cases were more than 171µmol/ml. Prothrombin time (PT) of 6 cases (50.0%) prolonged, prothrombin activity (PTA) of 3 cases (25.0%) were less than 40%, and serum albumin (Alb) of 7 cases (58.3%) decreased. Hepatomegaly was observed in 3 cases (25.0%), 1 case (8.3%) with splenomegalia and 3 cases (25.0%) with ascites. 8 cases (66.7%) were cured after anti-infection and liver protection therapy. 1 case (8.3%) was died and 3 cases (25.0%) were discharged. Conclusion  Liver dysfunction was generally found in the development process of Leptospirosis. Most of patients took a turn for the better in a short period of time. A minority of patients showed progressive development with liver sero-enzymes increased rapidly, and had serious jaundice and coagulation disorders. It should be distinguished with severe viral hepatitis. In severe cases, it even developed to liver failure and multiple organ function failure. The possibility of leptospirosis should be considered for patients with fever of unknown origin complicated with liver dysfunction.

Key words: Leptospirosis, Liver dysfunction, Clinical characteristic