新型冠状病毒感染儿童及青少年肝生物化学指标临床研究

Clinical analysis of liver chemistries in children and adolescent with 2019-nCoV infection

目的了解儿童及青少年新型冠状病毒(2019-nCoV)感染过程中肝功能(生化)指标变化情况。方法收集2020年1月19日至2020年11月28日复旦大学附属儿科医院收治的77例病原学确诊的2019-nCoV感染患儿的肝生化指标资料,分析其异常特征及危险因素。组间比较用t检验。结果77例2019-nCoV感染患儿中,男44例(57.1%),女33例(42.9%),中位年龄10岁。无症状感染27例(35.1%),轻型28例(36.4%),普通型22例(28.6%)。7例接受羟氯喹治疗。75例无基础疾病,其中丙氨酸转氨酶升高1例(1.5%,在使用羟氯喹过程中),天冬氨酸转氨酶升高7例(10.3%),碱性磷酸酶升高7例(28%),总胆红素、直接胆红素、白蛋白、国际标准化比值均在正常范围内。肺炎组与非肺炎组、红细胞沉降率升高组与正常组间肝生化异常差异无统计学意义(P>0.05)。1例基础疾病为胆道闭锁患儿,2019-nCoV感染后肝损伤无加重。1例基础疾病为癫痫,未出现肝生化异常。结论儿童及青少年2019-nCoV感染病例临床症状轻,肝损伤发生率低。2019-nCoV感染患儿的肝生化异常可能与其基础疾病及抗病毒治疗药物使用也相关。

Objective To describe the clinical features of liver involvement in children and adolescent with 2019-nCoV infection.Methods The clinical data of 77 hospitalized cases admitted to the Children’s Hospital of Fudan University were collected from January 19 to November 28,2020.The characteristics and risk factors of abnormal liver chemistries in children with laboratory-confirmed 2019-nCoV infection were analyzed.Results Of the 77 cases,44 were male(57.1%)and 33 were female(42.9%),with a median age of 10 years.27(35.1%)were asymptomatic,28(36.4%)had mild illness,22(28.6%)had non-severe pneumonia.Hydroxychloroquine was used in 7 cases.Of the 75 children without underlying diseases,alanine aminotransferase was elevated in 1 case(1.5%,during hydroxychloroquine therapy),aspartate aminotransferase was elevated in 7 cases(10.3%),alkaline phosphatase was elevated in 7 cases(28%),and total bilirubin,direct bilirubin,albumin,international normalized ratio were in normal range.There was no statistical difference between the pneumonia group and the non-pneumonia group in term of liver chemistries(P>0.05),same as between the elevated erythrocyte sedimentation rate group and the normal group.There was no aggravation of liver injury in the child with biliary atresia.The child with epilepsy showed no abnormal liver chemistries after infection.Conclusion Children with 2019-nCoV infection had mild clinical symptoms with few cases of liver injury.The abnormal liver chemistries in children with COVID-19 infection may be related to the underlying disease and the use of antiviral drugs.