2019冠状病毒病患者合并肝损伤的临床特点

Clinical characteristics of coronavirus disease 2019 patients complicated with liver injury

目的:探讨2019冠状病毒病(coronavirus disease 2019,COVID-19)合并肝损伤患者的临床特点、肝功能损害与临床分型的关系,以及COVID-19合并乙型肝炎病毒感染是否会加重肝损伤。方法:回顾性分析长沙市第一医院2020年1月17日至2月20日收治的110例确诊COVID-19患者中出现的肝功能异常情况,检测指标包括血清丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、白蛋白(albumin,ALB)、总胆红素(total bilirubin,TBIL)。结果:49.1%的COVID-19患者合并肝损伤。重型(危重型)患者与普通型(轻型)患者相比,ALT,AST和ALB的差异均有统计学意义(均P<0.05);而TBIL的差异无统计学意义(P>0.05)。乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)阳性COVID-19患者与HBsAg阴性COVID-19患者比较,肝功能损害的差异无统计学意义(P>0.05)。暂未发现急性肝损伤是导致患者死亡的直接原因。结论:COVID-19患者肝损伤发生率高,以ALT和AST轻至中度升高、ALB下降为主要特点。重型、危重型患者肝损伤的程度明显升高,其合并乙型肝炎病毒感染时,未显示加重肝损伤。

Objective:To analyze the clinical characteristics in patients of coronavirus disease 2019(COVID-19)complicated with liver injury,to explore the relationship between COVID-19 clinical classification and liver injury,and to elucidate whether COVID-19 complicated with hepatitis B virus can aggravate liver injury.Methods:The abnormal liver function in 110 patients in the First Hospital of Changsha,who were confirmed COVID-19 and admitted to the designated hospital from January 17,2020 to February 20,2020,wereretrospectively analyzed.The detection indexes included serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB),and total bilirubin(TBIL).Results:A total of 49.1%of the COVID-19 patients had liver injury.There were significant difference in the ALT,AST,ALB(all P<0.05),but there was no significant difference in the TBIL(P>0.05)between the severe(critical)patients and the general(light)patients.There was also no significant difference in the liver function injury between the HBsAg-positive COVID-19 patients and HBsAg-negative COVID-19 patients(P>0.05).Acute liver injury was not found to be a direct cause of death in the patients.Conclusion:In the COVID-19 patients,the incidence of liver injury is high with the increase of ALT and AST and the decrease of ALB.Severe and critical patients have obvious liver injury,and those patients complicated with hepatitis B virus infection don't show aggravated liver injury.