三氯乙烯药疹样皮炎患者肝功能动态变化

目的 观察职业性三氯乙烯( trichloroethylene,TCE)药疹样皮炎患者血清肝功能指标动态变化,为TCE药疹样皮炎肝损害的治疗提供依据.方法 收集10例职业性TCE药疹样皮炎并发肝损害患者不同时间点血清,采用全自动生化分析仪测定血清总蛋白(TP)、白蛋白( ALB)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)、AST/ALT比值、白蛋白/球蛋白比值(A/G)等11项指标,分析各指标动态变化.结果 10例TCE药疹样皮炎患者11项肝功能指标变化范围是TP:43.2～74.2 g/L,ALB:24.6～44.6 g/L,A/G:0.77～2.10,TBIL:3.7～268.2 μmol/L,DBIL:1.0～166.0 μmol/L,IBIL:2.4～167.5 μmol/L,ALT:11～5985 U/L,AST:14～5586 U/L,GGT:15～1500 U/L,ALP:35～309 U/L,S/L:0.07～1.94.TBIL、DBIL、ALT、AST、GGT、ALP浓度明显升高,尤以ALT、AST、GGT变化最明显;ALT最高达5985U/L,AST最高达5586 U/L,GGT最高达1500 U/L.TP、ALB、S/L明显降低,TP最低降到43.2g/L,S/L最低至0.07.A/G基本保持不变,IBIL变化不规律.结论 TCE药疹样皮炎患者早期肝损害严重,病情易反复发作.

Dynamic change study of dermatitis medicamentosa-like of trichloroethylene patients with liver damage

Objective Observing the dynamic change characteristics of serum liver function indexes in occupational dermatitis medicamentosa-like of trichloroethylene patients with liver damage,we can underlie for guiding therapy,prognosis and mechanism of dermatitis medicamentosa-like of trichloroethylene patients with liver damage.Methods We collected serum of 10 cases of occupational dermatitis medicamentosa-like of trichloro-ethylene patients with liver damage from different time points since they were hospitalized,using automatic biochemistry analyzer to detect total protein (TP),albumin (ALB),total bilirubin (TBIL),direct bilirubin (DBIL),indirect bilirubin (IBIL),alanine aminotransferase (ALT),aspartate aminotransferase (AST),gamma-glutamyl transpeptidase (GGT),alkaline phosphatase (ALP),albumin/globulin ratio etc 11 liver function biochemical indicators.We used Excel to establish database,professional drawing software gnuplot to draw dynamic variation diagram of each index.Results The variation range of 11 liver function indexes of 10 cases was TP 43.2～74.2 g/L,ALB 24.6～44.6 g/L,A/G 0.77～2.10,TBIL 3.7～268.2 μmol/L,DBIL 1.0～166.0 μmol/L,IBIL 2.4 ～167.5 μmol/L,ALT 11～5985 U/L,AST 14～5586 U/L,GGT 15～1500 U/L,ALP 35～309 U/L,S/L0.07～1.94,respectively.TBIL,DBIL,ALT,AST,GGT,ALP concentration significantly increased,especially ALT,AST,GGT,ALT topped 5985 U/L,AST topped 5586 U/L,GGT topped 1500 U/L.But TP,ALB and S/L significantly decreased,TP lowest to 43.2 g/L,S/L lowest to 0.07.A/G basically remained unchanged,but IBIL didn't change regularly.Conclusion The early liver damage in dermatitis medicamentosa-like of trichloroethylene patients was serious,and repeatedly attacked,so we should lead to enough attention to the clinical work and prevention.This also provided the basis for studying the mechanism of trichloroethylene poisoning.