内科

目的分析感染性休克患者继发肝损伤的临床特点及影响因素。方法采用横断面研究方法，选取336例感染性休克患者作为研究对象。根据是否继发肝损伤，将患者分为肝损伤组（156例）与对照组（无肝损伤，180例）。收集两组患者的一般资料、感染情况、疾病严重程度评分［急性生理和慢性健康状况Ⅱ（APACHEⅡ）评分、序贯器官衰竭评估（SOFA）评分］、实验室指标及并发症与预后指标。采用单因素分析与多因素logistic回归分析筛选感染性休克患者继发肝损伤的独立影响因素。结果肝损伤组患者的多器官功能障碍综合征发生率、凝血功能障碍发生率、重症监护病房住院时间及30 d内死亡率均高/长于对照组（均P<0.05）。单因素分析结果显示，两组在肺炎克雷伯菌感染、APACHEⅡ评分、SOFA评分、血小板计数、纤维蛋白原（Fib）水平、D-二聚体水平方面差异均有统计学意义（均P<0.05）。多因素logistic回归分析结果显示，SOFA评分升高（OR=1.358，95%CI：1.205～1.530）、D-二聚体水平升高（OR=1.044，95%CI：1.024～1.065）均是感染性休克患者继发肝损伤的独立危险因素，高血小板计数（OR=0.955，95%CI：0.992～0.998）、高Fib水平（OR=0.771，95%CI：0.645～0.922）均是其独立保护因素（均P<0.05）。结论继发肝损伤的感染性休克患者临床预后更差。SOFA评分、血小板计数、Fib水平和D-二聚体水平是感染性休克患者继发肝损伤的独立影响因素，监测这些指标有助于早期识别高危患者。

Objective To analyze the clinical characteristics and influencing factors of secondary liver injury in patients with septic shock. Methods A cross-sectional study was conducted, and 336 patients with septic shock were selected as the research subjects. According to the presence or absence of secondary liver injury, the patients were divided into either the liver injury group (n=156) or the control group (without liver injury, n=180). General data, infection status, disease severity scores (Acute Physiology and Chronic Health Evaluation Ⅱ [APACHE Ⅱ] score, Sequential Organ Failure Assessment [SOFA] score), laboratory indicators, complications, and prognostic indicators of the two groups were collected. Univariate analysis and multivariate logistic regression analysis were used to screen the independent influencing factors of secondary liver injury in patients with septic shock. Results The incidence of multiple organ dysfunction syndrome, incidence of coagulation disorders, length of stay in the intensive care unit, and 30-day mortality in the liver injury group were all higher/longer than those in the control group (all P<0.05). Univariate analysis results showed that there were statistically significant differences between the two groups in Klebsiella pneumoniae infection, APACHE Ⅱ score, SOFA score, platelet count, fibrinogen (Fib) level, and D-dimer level (all P<0.05). Results of multivariate logistic regression analysis showed that increased SOFA score (OR=1.358, 95% CI: 1.205-1.530) and increased D-dimer level (OR=1.044, 95% CI: 1.024-1.065) were independent risk factors for secondary liver injury in patients with septic shock; while high platelet count (OR=0.955, 95% CI: 0.992-0.998) and high Fib level (OR=0.771, 95% CI: 0.645-0.922) were independent protective factors (all P<0.05). Conclusion Patients with septic shock complicated by secondary liver injury have a worse clinical prognosis. SOFA score, platelet count, Fib level, and D-dimer level are independent influencing factors for secondary liver injury in patients with septic shock; monitoring these indicators may aid in the early identification of high-risk patients.