新型冠状病毒肺炎患者消化系统表现的回顾性研究

Retrospective analysis of digestive system manifestations in patients with coronavirus disease 2019

背景新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)在全球范围内蔓延,以呼吸道症状为主要表现,部分患者合并明显的消化系统表现,甚至仅表现为消化系统症状.因此,明确COVID-19患者的消化系统表现及其规律,具有重要意义.目的探讨我院350例COVID-19住院患者消化系统表现,为COVID-19的诊断和治疗提供一定的帮助及参考.方法回顾性分析武汉市第四医院COVID-19住院患者资料,如一般情况、起始症状、疾病危重程度、消化系统症状、肝功能指标等.对COVID-19非危重组及危重组患者的消化系统症状、肝功能指标进行比较.统计学方法采用独立样本中位数检验、连续性校正卡方检验、单因素方差分析.结果350例患者均为COVID-19确诊患者,男性176例(50.3%),女性174例(49.7%);年龄范围17-94岁,中位年龄59岁;非危重组254例(72.6%),危重组96例(27.4%).首发症状以发热、干咳、乏力、胸闷等为主.262例(74.9%)出现发热,189例(54.0%)患者出现干咳,237例(67.7%)出现乏力,195例(55.7%)出现胸闷,212例(60.6%)出现纳差.79例(22.6%)患者出现消化系统症状,主要表现为腹泻、呕吐、腹痛等症状.42例(12.0%)患者出现腹泻,48例(13.7%)患者出现呕吐,3例(0.9%)患者出现腹痛.5例(1.4%)患者以单纯消化系统症状为首发症状.150例(42.9%)患者出现肝功能指标异常(ALT、AST、TBIL、DBIL至少一项升高),其中73例(20.9%)ALT升高,98例(28.0%)AST升高,60例(17.1%)DBIL升高,27例(7.7%)TBIL升高.此外,275例(78.6%)血白蛋白(ALB)浓度降低.非危重组患者出现消化系统症状的比率(52/254,20.5%)与危重组患者(27/96,28.1%)相比,差异不具有统计学意义(χ^2=2.334,P>0.05).非危重组患者肝功能指标异常比率(87/254,34.3%)与危重组患者(63/96,65.6%)相比,差异具有统计学意义(χ^2=28,P<0.05).非危重组ALB降低的比率(182/254,71.7%)与危重组(93/96,96.9%)相比,差异具有统计学差异(χ^2=26.322,P<0.05).无论是非危重组,还是危重组,肝功能指标升高多数不超过2ULN,ALB降低多数在30-40 g/L范围.腹泻组ALB降低的比率(39/42,92.9%)与非腹泻组(236/308,76.6%)相比,差异具有统计学意义(χ^2=5.785,P<0.05).不同白蛋白浓度分组之间的发病时间无统计学差异(P>0.05).结论COVID-19住院患者部分合并消化系统症状,以腹泻、呕吐症状较常见,少数患者以单纯消化系统症状为首发表现,易于误诊.部分COVID-19患者合并肝损伤,多数轻微,无肝衰竭发生,提示新型冠状病毒可能对肝脏有一定的损伤作用.非危重组与危重组相比,消化系统症状的发生率总体相近,但是危重组肝功能指标异常发生率及异常程度更高.COVID-19患者多数可出现血白蛋白浓度降低,腹泻患者更容易出现血白蛋白浓度降低.以上结论有助于临床医生加深对该疾病的认知,并提高治疗水平.

BACKGROUND Coronavirus disease 2019(COVID-19)is spreading around the world,presenting mainly as respiratory symptoms.Some patients have obvious digestive system symptoms,or even present with only digestive system symptoms.Therefore,it is of great significance to clarify the digestive system manifestations in COVID-19 patients.AIM To explore the digestive system manifestations of 350 patients with COVID-19 hospitalized at our hospital,to provide reference for the diagnosis and treatment of COVID-19.METHODS The data of 350 COVID-19 inpatients at our hospital,such as general conditions,initial symptoms,disease severity,digestive system symptoms,and liver function,were retrospectively analyzed.The digestive system symptoms and liver function indexes were compared between noncritically ill patients and critically ill patients.Statistical methods involved independent sample median test,continuity correction chi-square test,and one-way analysis of variance.RESULTS All the 350 patients were definitely diagnosed with COVID-19,including 176(50.3%)males and 174(49.7%)females.They ranged in age from 17 to 94 years,with a median age of 59 years.There were 254(72.6%)noncritically ill patients and 96(27.4%)critically ill patients.The initial symptoms were mainly fever,dry cough,fatigue,and chest tightness;262(74.9%)cases showed fever,189(54.0%)showed dry cough,237(67.7%)showed fatigue,and 195(55.7%)showed chest tightness.Seventynine(22.6%)cases showed digestive system symptoms,mainly diarrhea,vomiting,and abdominal pain;42(12.0%)cases showed diarrhea,48(13.7%)showed vomiting,and 3(0.9%)showed abdominal pain.Five(1.4%)cases presented with digestive system symptoms as the initial symptoms.One hundred and fifty(42.9%)cases had abnormal liver function indexes(increase in at least one of ALT,AST,TBIL,and DBIL),of which 73(20.9%)had elevated ALT,98(28.0%)had elevated AST,60(17.1%)had elevated DBIL,and 27(7.7%)had elevated TBIL.Serum albumin(ALB)was reduced in 275(78.6%)patients.The percentage of non-critically ill patients with digestive system symptoms(52/254,20.5%)was not statistically significant from that of critically ill patients(52/254[20.5%]vs 27/96[28.1%],χ^2=2.334,P>0.05).The abnormal rate of liver function indexes(87/254,34.3%)was significantly lower in non-critically ill patients than in critically ill patients(87/254[34.3%]vs 63/96[65.6%],χ^2=28,P<0.05).The percentage of patients with ALB decline was significantly lower in non-critically ill patients than in critically ill patients(182/254[71.7%]vs 93/96[96.9%],χ^2=26.322,P<0.05).In both non-critically ill and critically ill patients,the increase in liver function indexes was mostly not more than 2×upper limit of normal,and ALB was mostly in the range of 30-40 g/L.Compared with the non-diarrhea group(236/308,76.6%),the percentage of patients with ALB reduction in the diarrhea group(39/42,92.9%)was statistically lower(χ^2=5.785,P<0.05).There was no statistically significant difference in duration of onset between groups with different albumin concentrations(P>0.05).CONCLUSION Hospitalized COVID-19 patients may show some digestive system symptoms,with diarrhea and vomiting being most common.A few patients present with digestive system symptoms as the initial manifestation,which is more likely to cause misdiagnosis.Some patients with COVID-19 show liver injury,although most of cases are mild,and no liver failure occurs.Compared with noncritically ill patients,the incidence of digestive system symptoms is generally similar to that of non-critically ill patients,but the incidence and degree of abnormal liver function indexes are higher in critically ill patients.Most patients with COVID-19 may have decreased serum albumin,and patients with diarrhea are more likely to have serum albumin decline.The above conclusions may help increase the awareness of COVID-19 among clinicians and improve their treatment skills.