武汉地区110例COVID-19患者入院时肝功能分析

Analysis of liver function of COVID-19 patients on admission in Wuhan

目的比较轻重症新型冠状病毒肺炎(COVID-19)患者入院时的肝功能,分析肝功能异常的原因,探讨疾病预后指标。方法收集55例非重症COVID-19患者(非重症组)和55例重症COVID-19患者(重症组)的临床资料。回顾性分析COVID-19患者入院后首次检查的肝功能指标ALT、AST、TB、DB、ALB、ALP、GGT、LDH。采用t检验和卡方检验进行统计学分析,绘制受试者工作特征曲线(ROC曲线),计算灵敏度、特异度和曲线下面积(AUC)。并采用多因素Logistic回归方法对COVID-19患者进展为重症COVID-19的高危因素进行分析。结果两组患者性别、年龄、TB、DB比较差异无统计学意义(P>0.05),重症组与非重症组比较,ALT、AST、ALB、ALP、GGT、LDH显著升高,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,入院时AST、LDH是COVID-19发展为重症COVID-19的独立危险因素(P<0.05)。ROC曲线分析显示,单独检测AST预测COVID-19严重程度的AUC为0.796(95%CI:0.712~0.880),最佳截断值为:44.5 U/L(灵敏度58.2%、特异度90.9%);单独检测LDH预测COVID-19严重程度的AUC为0.783(95%CI:0.696~0.870),最佳截断值为:393.5 U/L(灵敏度56.4%、特异度96.4%);AST和LDH联合检测的AUC为0.819,其灵敏度、特异度分别为65.5%、87.3%。结论COVID-19患者肝功能异常发生率较高,在治疗原发病的同时要注意肝功能的保护,AST、LDH水平有可能成为COVID-19严重程度和预后判断的指标之一。

Objective to compare the results of liver function of non-severe and severe COVID-19(COVID-19)patients on admission,analyze the causes of abnormal liver function,and explore the prognosis indexes of COVID-19.Methods The clinical data of 55 patients with non-severe COVID-19(non-severe group)and 55 patients with severe COVID-19(severe group)were collected.The liver function indexes ALT,AST,TB,DB,ALB,ALP,GGT and LDH of COVID-19 patients examined for the first time after admission were analyzed,retrospectively.T-test and chi-square test were used for statistical analysis.The receiver working characteristic curve(ROC curve)was drawn,and the sensitivity,specificity and area under the curve(AUC)were calculated.Multivariate Logistic regression was used to analyze the high risk factors for the progression of severe pneumonia in patients with COVID-19.Results There was no significant difference in sex,age,TB and DB between the two groups(P>0.05).The levels of ALT,AST,ALB,ALP,GGT and LDH in the severe group were significantly higher than those in the non-severe group(P<0.05).Multivariate Logistic regression analysis showed that AST and LDH were independent risk factors for the development of COVID-19 into severe COVID-19 on admission.ROC curve analysis showed that the AUC for predicting the severity of COVID-19 by AST alone was 0.796(95%CI:0.712-0.880),and the best cut-off value was 44.5 U/L(sensitivity 58.2%,specificity 90.9%).The AUC for predicting the severity of COVID-19 by LDH alone was 0.783(95%CI:0.696-0.870),and the best cut-off value was 393.5 U/L(sensitivity 56.4%,specificity 96.4%);The AUC of AST and LDH combined detection was 0.819,the sensitivity and specificity were 65.5%and 87.3%,respectively.Conclusion The incidence of abnormal liver function in patients with COVID-19 is high.Attention should be paid to the protection of liver function while treating the primary disease.The levels of AST and LDH may be the indexes to judge the severity and prognosis of COVID-19.