2019-nCoV患者肝损伤临床特点及预后分析

Clinical features and prognosis of liver injury in patients with 2019-nCoV infection

[目的]探讨及明确2019新型冠状病毒(2019-nCoV)患者肝损伤临床特点及与疾病严重程度的相关性。[方法]纳入在本院住院确诊2019-nCoV感染相关的肺炎病例共计160例,其中普通型131例,重型10例,危重型19例。通过电子病例收集患者临床特点及实验室肝功能各项指标(AST、ALT、TBil、DBil、ALP、γ-GT、ALB),对上述指标与疾病严重程度进行秩和检验、t检验及χ~2检验统计学分析。[结果]重型、危重型、普通型患者肝损伤发生率分别为100.0%(10/10)、100.0%(19/19)、54.2%(71/131),重型及危重型与普通型患者肝损伤发生率比较均差异有统计学意义(χ~2=10.000,P<0.05)。重型及危重型、普通型ALT升高比例分别为31.0%(9/29)、2.3%(3/131),二者比较差异有统计学意义(Z值=-4.153,P<0.05);重型及危重型、普通型AST升高比例分别为44.8%(13/29)、3.8%(5/131),二者比较差异有统计学意义(Z值=-4.012,P<0.05)。重型及危重型、普通型TBil升高分别为27.6%(8/29)、0.8%(1/131),二者比较差异有统计学意义(Z值=-2.833,P<0.05)。重型及危重型、普通型DBil升高分别为37.8%(11/29)、2.3%(3/131),二者比较差异有统计学意义(Z值=-4.125,P<0.05)。重型及危重型、普通型γ-GT升高比例分别为55.2%(16/29)、6.9%(9/131),二者比较差异有统计学意义(Z值=-5.165,P<0.05)。重型及危重型、普通型ALB下降比例分别为79.3%(23/29)、38.9%(51/131),ALB值分别为(35.86±6.43)g/L、(40.69±4.08)g/L,二者比较均差异有统计学意义(t=5.186,P<0.05)。[结论]2019-nCoV感染相关肺炎,在重型及危重型患者中肝损伤的发生率很高,均以ALT、AST、TBil、DBil、γ-GT轻度升高及ALB轻中度下降为主,普通型患者出现肝损伤的比例及严重程度均明显低于重型及危重型患者,可以将肝功能各项指标作为判断疾病程度及预后的参考指标。

[Objective]The purpose of our study was to explore and identify the clinical characteristics of liver injury and its correlation with disease severity in patients with 2019-nCoV infection,so as to provide clinical reference indexes for the assessment of disease prognosis in future clinical work.[Methods]In this retrospective study,we included a total of 160cases of 2019-nCoV infection-related pneumonia confirmed in the Xiangyang Center Hospital of Hubei province during January 19,2020-February 29,2020.The clinical characteristics and laboratory liver function indicators(AST,ALT,TBil,DBil,ALP,γ-GT,ALB)of the patients were collected by electronic case collection system.The Rank sum test,Student t test and Chi-square test were used to analyze the relationship between these indicators and disease severity.[Results]In severe and critical patients,the incidence of liver injury was 100%(29/29),the incidence of liver injury was 54.2%(71/131)in the ordinary type,the difference of liver injury rate was statistically significant(χ2=10.000,P<0.05).ALT elevation happened in 2.3%(3/131)of the ordinary type,and 31%(9/29)for the severe and critical patients.The elevated ALT level in the severe and critical patients was significantly higher than that of the ordinary type,and the difference was statistically significant(Z=-4.153,P<0.05).AST elevation happened in 3.8%(5/131)for the ordinary type,and 44.8%(13/29)for the severe and critical patients.The elevated AST level in the severe and critically ill patients was significantly higher than that of the ordinary type,and the difference was statistically significant(Z=-4.012,P<0.05).TBil elevation happened in 0.8%(1/131)of the ordinary type,and 27.6%(8/29)of the severe and critically patients.The TBil elevation in the severe and critical patients was significantly higher than that of the ordinary type,and the difference was statistically significant(Z=-2.833,P<0.05).DBil elevation happened in 2.3%(3/131)of the ordinary type,and 37.8%(11/29)of the severe and critical patients,The D.Bil elevation in the severe and critical patients was significantly higher than that of the ordinary type,and the difference was statistically significant(Z=-4.125,P<0.05).γ-GT elevation was 6.9%(9/131)in the ordinary type,and 55.2%(16/29)in the severe and critical patients.Theγ-GT elevation in the severe and critical patients was significantly higher than that of the ordinary type,and the difference was statistically significant(Z=-5.165,P<0.05).The decrease of ALB was 38.9%(51/131)in the ordinary type,79.3%(23/29)in the severe and critical patients(40.69±4.08g/L vs 35.86±6.43g/L),and the difference was statistically significant(t=5.186,P<0.05).[Conclusion]In the 2019-nCoV infection associated pneumonia,the proportion and severity of liver injury in ordinary type patients are significantly lower than those in severe and critical patients,which present with AST,ALT,TBil,DBil,ALP,γ-GT slightly increased and ALB slightly decreased.The changes of liver function indexes are statistically significant.Therefore,indexes of liver function can be used as reference indexes to judge the degree of disease and prognosis.