摘要肝外危重症与肝脏疾病均可发生肝损伤或肝衰竭.肝脏参与代谢、解毒、免疫、合成、排泄等多方面生理功能,肝损伤的不同病理生理阶段宜采取个体化、针对性靶向治疗策略.传统肝功能指标如丙氨酸转氨酶(ALT)和血清总胆红素(TBIL)等在早期识别和精准评估肝损伤严重程度方面存在局限,探索肝损伤新型生物标志物有助于早期发现肝受损.本文从代谢(胆汁酸、铁代谢)、氨类解毒(鸟氨酸循环通路关键蛋白Arg Ⅰ、OCT和ASS)、线粒体功能(关键酶GLDH和MDH)、肝细胞分泌(CK18、HMGB1和miR122)和免疫功能(MIF)等方面,梳理新近用于肝损伤评估的新型标志物.

abstractsLiver injury is an independent risk factor for worse prognosis of patients with critically ill. The criteria for diagnosis of liver injury are based on the levels of alanine aminotransferase( ALT ≥ 2 fold the upper limit of normality)or total bilirubin(TBIL≥68 μmol/L). All these classic indicators have limita-tion to early identify liver injury. Recently,accumulated evidences indicated that novel potential biomarkers for predicting liver injury are worth more attention due to quick response to liver injury up to 0. 5-2 h. Here, we summarized these potential biomarkers including serum total bile acids,bile acids profiling,regulator of iron metabolism(transferrtin,ferritin and hepcidin),enzymes involved in mitochondria function(GLDH and MDH),key proteins for ornithine circulation pathway ( Arg Ⅰ,OCT and ASS),hepatocytes-derived cyto-kines(CK18,HMGB1 and miR122)and immunologic regulator(MIF).