重型/危重型新型冠状病毒肺炎患者合并肝脏损伤及凝血功能障碍的研究

The Liver Injury and Coagulation Dysfunction in the Patients with Severe/Critical COVID-19

目的:分析重型及危重型新型冠状病毒肺炎(COVID-19)患者合并肝脏损伤及凝血功能障碍的情况。方法:收集华中科技大学同济医学院附属同济医院中法新城院区山西队2020年2月8日至3月25日诊治的53例重型及危重型COVID-19患者的病历资料,将患者分为重型组(38例)和危重型组(15例),回顾性分析不同临床分型患者的临床特征及入院时肝功能、凝血功能及炎症指标的变化;将患者按诊疗过程中肝功能异常程度分为肝脏损伤组、肝功能轻度异常组以及肝功能正常组,比较各组患者相应时间节点碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(GGT)、降钙素原(PCT)、超敏C反应蛋白(hs CRP)、D-二聚体水平的变化。分析所有患者疾病转归。采用独立样本t检验、Mann-Whitney U检验、Kruskal-Wallis检验、卡方检验进行统计学分析。结果:53例重型及危重型COVID-19患者中位年龄为57(27-80)岁,其中男性29例(54.7%),女性24例(45.3%)。起病至入院的时间为(11.5±7.7)d。危重型较重型患者AST、TBil、DBil、ALP、GGT、LDH、D-二聚体、PCT、hs CRP水平明显增高,而Alb水平明显降低(P<0.05)。53例患者中,共有34例(64%)患者出现ALT、AST或TBil异常升高,4例(7.5%)符合COVID-19合并肝脏损伤。根据肝功能异常程度分组后,肝脏损伤组ALP、GGT、D-二聚体水平较肝功能正常组明显升高(P<0.05),肝脏损伤组D-二聚体水平较肝功能轻度异常组明显升高(P<0.05),肝功能轻度异常组ALP、GGT较肝功能正常组明显升高(P<0.05)。结论:本组患者中,7.5%的重型及危重型COVID-19患者合并肝脏损伤并伴有D-二聚体水平明显升高,危重型患者较重型患者存在更严重的肝脏损伤及凝血功能障碍,二者可能共同促进COVID-19的疾病进展。

Objective:To analyze the liver injury and coagulation dysfunction in COVID-19 severe/critical type patients.Methods:The clinical data of 53 COVID-19 patients were collected from a single center in Wuhan from February 8,2020 to March 25,2020.The patients were divided into severe type group(38 patients)and critical type group(15 patients).The clinical characteristics,indexes of liver function,coagulation function and inflammatory markers were analyzed retrospectively.According to the degree of abnormal liver function in the process of diagnosis and treatment,the patients were divided into three groups:combined liver injury,mild abnormal liver function and normal liver function group.Statistical analysis was performed by using Student t test,Mann-Whitney U test,Kruskal-Wallis test and Chi-square test.Results:Among the 53 patients,29 were male(54.7%)and 24 were female(45.3%),the median age was 57(27-80)years old.The time from onset to admission was(11.5±7.7)days.The levels of AST,TBIL,DBIL,ALP,GGT,LDH,D-dimer,PCT and hsCRP in critical patients were higher than those in severe patients(P<0.05).The levels of Alb in critical patients was lower than those in severe patients(P<0.05).Among the 53 patients,34(64%)patients showed abnormal elevation of ALT,AST or TBIL,while 4(7.5%)patients showed the criteria of COVID-19 with liver injury.After the patients were grouping according to the degree of liver dysfunction,the levels of ALP,GGT and D-dimer of the patients in the liver injury group were significantly higher than those in the normal liver function group,D-dimer levels of the patients in the liver injury group was significantly higher than those in the mild abnormal liver function group,while the levels of ALP and GGT in the mild abnormal liver function group were significantly higher than those in the normal liver function group,and the differences were statistically significant(P<0.05).Conclusion:In this group,the patients with COVID-19 severe/critical type have a certain proportion of liver injury accompanied by significantly increased D-dimer levels,critical type patients have more severe liver function and coagulation dysfunction,which may promote the progression of COVID-19.