新型冠状病毒肺炎与肝功能损伤的关系初探:一项多中心研究

Preliminary study of the relationship between novel coronavirus pneumonia and liver function damage:a multicenter study

目的分析新型冠状病毒肺炎病例的临床特征,初步探讨不同临床分型与肝功能损伤的关系。方法纳入2020年1月23日到2020年2月8日7家新型冠状病毒感染定点医院连续收治的确诊病例。根据国家卫生健康委员会发布的《新型冠状病毒感染的肺炎诊疗方案(试行第五版修正版)》进行临床分型(轻型、普通型、重型、危重型)。研究数据采用SPSS19.0统计学软件进行分析。定量资料采用中位数(四分位数间距)表示,定性资料采用频数和率表示。两组数据之间的差异性分析采用秩和检验。结果纳入了符合标准的32例确诊病例,轻型或普通型28例(87.50%),重型或危重型4例(12.50%)。4例(12.50%)患者合并有1项基础疾病(支气管哮喘、冠心病、恶性肿瘤、慢性肝脏疾病各1例),1例(3.13%)患者同时合并有高血压和恶性肿瘤。实验室检查结果提示:总队列病例的丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)分别为26.98(16.88~46.09)U/L和24.75(18.71~31.79)U/L,白蛋白(Alb)和总胆红素(TBil)分别为39.00(36.20~44.20)g/L和16.40(11.34~21.15)μmol/L。轻型或普通型亚组的ALT和AST分别为22.75(16.31~37.25)U/L和23.63(18.71~26.50)U/L,其中ALT>40 U/L有6例(21.00%),AST>40 U/L有1例(3.60%);Alb和TBil分别为39.70(36.50~46.10)g/L和15.95(11.34~20.83)μmol/L。重型或危重型亚组的ALT和AST分别为60.25(40.88~68.90)U/L和37.00(20.88~64.45)U/L,其中ALT>40 U/L有3例(75.00%),AST>40 U/L有1例(25.00%);Alb和TBil分别为35.75(28.68~42.00)g/L和20.50(11.28~25.00)μmol/L。结论多中心回顾性研究结果提示新型冠状病毒肺炎合并肝功能损伤在轻型和普通型患者中少见,而在重型和危重型患者中多见。因此,应当加强对重症患者治疗期间的肝功能监测与评估。

Objective To analyze the clinical characteristics of cases of novel coronavirus pneumonia and a preliminary study to explore the relationship between different clinical classification and liver damage.Methods Consecutively confirmed novel coronavirus infection cases admitted to seven designated hospitals during January 23,2020 to February 8,2020 were included.Clinical classification(mild,moderate,severe,and critical)was carried out according to the diagnosis and treatment program of novel coronavirus pneumonia(Trial Fifth Edition)issued by the National Health Commission.The research data were analyzed using SPSS19.0 statistical software.Quantitative data were expressed as median(interquartile range),and qualitative data were expressed as frequency and rate.Results 32 confirmed cases that met the inclusion criteria were included.28 cases were of mild or moderate type(87.50%),and four cases(12.50%)of severe or critical type.Four cases(12.5%)were combined with one underlying disease(bronchial asthma,coronary heart disease,malignant tumor,chronic kidney disease),and one case(3.13%)was simultaneously combined with high blood pressure and malignant tumor.The results of laboratory examination showed that the alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB),and total bilirubin(TBil)for entire cohort were 26.98(16.88~46.09)U/L and 24.75(18.71~31.79)U/L,39.00(36.20~44.20)g/L and 16.40(11.34~21.15)μmol/L,respectively.ALT,AST,ALB and TBil of the mild or moderate subgroups were 22.75(16.31~37.25)U/L,23.63(18.71~26.50)U/L,39.70(36.50~46.10)g/L,and 15.95(11.34~20.83)μmol/L,respectively.ALT,AST,ALB and TBil of the severe or critical subgroups were 60.25(40.88~68.90)U/L,37.00(20.88~64.45)U/L,35.75(28.68~42.00)g/L,and 20.50(11.28~25.00)μmol/L,respectively.Conclusion The results of this multicenter retrospective study suggests that novel coronavirus pneumonia combined with liver damage is more likely to be caused by adverse drug reactions and systemic inflammation in severe patients receiving medical treatment.Therefore,liver function monitoring and evaluation should be strengthened during the treatment of such patients.