新型冠状病毒肺炎患者肝损伤临床分析

Clinical analysis of liver injury in patients with COVID-19

目的:总结新型冠状病毒肺炎患者发生肝损伤的临床特点。方法:回顾性分析南京市公共卫生医疗中心住院治疗的93例确诊新型冠状病毒肺炎患者的临床资料。结果:93例中,肝损伤38例(40.9%),其中男27例,女11例,年龄26~87岁,平均48岁。肝损伤患者中,肝功能异常表现为总胆红素(total bilirubin,TBIL)及谷氨酸氨基转氨酶(alanine aminotransferase,ALT)/天门冬氨酸氨基转氨酶(aspartate aminotransferase,AST)升高,其中,TBIL异常者9例,ALT/AST异常者25例,TBIL合并ALT/AST异常者4例,TBIL增高均在3倍以内,ALT/AST增高均在5倍以内。19例(50.0%)入院时已有肝损伤,19例(50.0%)入院后出现肝损伤,两组TBIL、ALT及AST分别为(16.4±2.0)μmol/L vs.(17.8±2.4)μmol/L(P=0.43);(56.3±8.6)U/L vs.(52.02±6.3)U/L(P=0.69);(42.8±4.7)U/L vs.(31.92±2.4)U/L(P=0.04)。结论:新型冠状病毒肺炎确诊患者中,肝损伤的发生比例高,程度较轻,大部分可自行恢复,但肝损伤的机制复杂,除了病毒本身所致肝损伤还可能合并药物性肝损伤,在诊治过程中需要注意防治。

Objective:This study aims to summarize the clinical characteristics of liver injury in patients with corona virus disease2019(COVID-19).Methods:The clinical data of 93 patients with COVID-19 who were hospitalized in Nanjing Public Health Medical Center were retrospectively analyzed.Results:Among the 93 patients,38(40.9%)had liver injury,including 27 males and 11 females,aged 26-87 years,with an average age of 48.Among these patients with liver injury,the abnormal liver function was manifested as increased total bilirubin(TBIL)and alanine aminotransferase(ALT)/aspartate transaminase(AST),9 patients with abnormal TBIL,25 patients with abnormal ALT/AST,and 4 patients with abnormal TBIL combined with ALT/AST.The increase of TBIL was within 3 times and the increase of ALT/AST within 5 times.Among the 38 patients with liver injury,19(50%)suffered liver injury when admission,and 19(50%)suffered liver injury after admission.The value of TBIL,ALT and AST in the two groups were(16.4±2.0)μmol/L vs.(17.8±2.4)μmol/L(P=0.43),(56.3±8.6)U/L vs.(52.02±6.3)U/L(P=0.69),and(42.8±4.7)U/L vs.(31.92±2.4)U/L(P=0.047),respectively.Conclusion:Among the patients diagnosed with COVID-19,the incidence of liver injury is high and the severity is relatively mild,and most of them can recover by themselves.However,the mechanism of liver injury is complex,and in addition to the liver injury caused by the virus,it may also be combined with drug-induced liver injury,which should be paid attention to in the process of diagnosis and treatment.