关键词: 休克, 缺氧性肝炎, 儿童, 危险因素

Abstract:

Objective To investigate the clinical characteristics and risk factors of the occurrence of hypoxic hepatitis （HH） in children with shock. Methods Clinical data （general situation， clinical situation and prognosis） of 234 children with different types of shock admitted to the pediatrics department of Hainan Women and Children's Medical Center from January 2016 to December 2023 were collected. Serum biochemical indexes on day 1 （d1）， day 2 （d2）， day 3 （d3）， day 5 （d5）， day 7 （d7） of children with shock were collected， including serum alanine aminotransferase （ALT）， glutamate aminotransferase （AST）， lactate dehydrogenase （LDH）， alkaline phosphatase （ALP）， albumin （ALB）， total bilirubin （TBIL）， urea nitrogen （BUN）， C reactive protein （CRP）， international standardized time （INR） and lactate. And the clinical characteristics and risk factors of the occurrence of HH in children with shock were analyzed. Results A total of 234 cases （150 cases of males）of different types of shock in children were enrolled， ages ranged from 1 month to 16 years old. According to whether developed HH， the children with shock were divided into HH group （32 cases） and non-HH group （202 cases）. The total incidence of HH was 13.7% （32/234）. Septic shock was the main disease of the occurrence of HH in children with shock， accounting for 65.63% （21/32）. According to the prognosis， children with shock combined HH were divided into survival group （17 cases） and death group （15 cases）. The case fatality rate of children with shock combined HH was 46.9%. The ALT and AST values in children with shock combined HH were more than 20 times of the upper limits of normal ranges. The peak values of enzymatic indexes in the survival group appeared at the onset time d 1 to d 2， they were close to the normal ranges at the onset time d7， while the enzymatic indexes in the death group were higher than the normal ranges during the whole disease stage. Compared with the survival group， the peak values of ALT， AST， ALP， TBIL， CRP， BUN， and INR in the death group were obviously higher （P < 0.05， both）. The lowest value of ALB in the death group was lower than that in the survival group （P < 0.05）. The results of multivariate Logistic regression analysis showed that pediatric critical illness score（PCIS）， lactate， multiple organ dysfunction syndrome （MODS）， decompensated shock and cardiogenic shock were the risk factors for the occurrence of HH in children with shock（P < 0.05 or 0.01）， and left ventricular ejection fraction（LVEF） and mean arterial pressure （MAP） were the risk factors of the death of HH in children with shock （P < 0.01）. Conclusions Children with shock who have the risk factors as decreased PCIS， increased lactate level， MODS， decompensated shock and cardiogenic shock are apt to suffer from HH. Poor prognosis in the children with shock combined HH is associated with worse condition and lower LVEF. There is a high fatality rate of shock combined HH in children， so that liver function indicators should be closely monitored to early detect HH， and reasonable treatment should be given.

Key words: shock, hypoxic hepatitis, children, risk factors