慢性乙型肝炎合并新型冠状病毒肺炎患者的肝功能特点分析

Characteristics of liver function of patients with chronic hepatitis B and coronavirus disease 2019

目的研究慢性乙型肝炎合并新型冠状病毒肺炎(COVID-19)患者的肝功能特点,为临床治疗提供依据。方法纳入2020年2月1日至2月20日同济医院收治的慢性乙型肝炎合并COVID-19的住院患者,观察其临床特征、肝功能指标及预后,并分析服用核苷类药物对患者肝功能及预后的影响。结果合并COVID-19的慢性乙型肝炎患者93例,平均年龄(60.85±13.42)岁,其中男性49例(52.69%),女性44例(47.31%);4例(4.30%)患者出现慢加急性肝衰竭,7例(7.53%)死亡。多数患者存在不同程度的肝功能异常,包括丙氨酸转氨酶(ALT)升高(22.58%)、天冬氨酸转氨酶(AST)升高(31.18%)、总胆红素升高(7.53%)、γ-谷氨酰转肽酶升高(9.60%)、乳酸脱氢酶升高(74.19%)、白蛋白降低(47.31%)、凝血酶原时间延长(10.75%)、凝血酶原活动度下降(15.05%)。90例(96.77%)患者乙肝病毒e抗原检测呈阴性。10例(10.75%)患者正在服用核苷类抗乙肝病毒药物,与未服药患者相比,肝功能及预后指标无明显差异。结论慢性乙型肝炎合并COVID-19的患者肝功能异常较为常见,少数可出现慢加急性肝衰竭,治疗时需重视肝功能的情况。对这类患者使用核苷类药物抗乙肝病毒治疗是安全的。

Objective To study the characteristics of liver function of patients with chronic hepatitis B(CHB)and COVID-19 in order to provide evidence for clinical treatment.Methods Patients with CHB and COVID-19 admitted to Tongji Hospital between February 1 and February 20,2020 were enrolled in this study.The clinical features,liver function indexes and prognosis were observed,and the effects of nucleoside drugs on liver function and prognosis were analyzed.Results Among the 93 CHB patients with COVID-19,the average age was 60.85±13.42 years,including 49 males(52.69%),and 44 females(47.31%).Four patients(4.30%)developed acute-on-chronic liver failure(ACLF).Seven cases(7.53%)died.Most of the patients had different degrees of abnormal liver function,including elevation of alanine transaminase(22.58%),aspartate transaminase(31.18%),total bilirubin(7.53%),gamma-glutamyl transferase(9.60%),lactate dehydrogenase(74.19%),and decrease of albumin(47.31%).Prothrombin time was prolonged in 10.75%of the patients.Prothrombin time activity was decreased in 15.05%of the patients.90(96.77%)patients were negative for hepatitis e antigen.10(10.75%)patients were taking anti-HBV nucleoside drugs.There was no significant difference in liver function and prognosis between those who took nucleoside drugs and those who did not.Conclusion Abnormal liver function is common in patients with CHB and COVID-19.A few patients could develop ACLF.Liver function deserves attention in the course of treatment.Anti-HBV treatment with nucleoside drugs is safe in these patients.