新型冠状病毒肺炎患者合并肝功能损伤临床特征

Clinical characteristics of COVID-19 patients with liver injury

目的探讨新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)合并肝损伤的临床特点,为临床诊治提供依据。方法对广州医科大学附属市八医院2020年1月20日至2020年2月17日收治的107例COVID-19合并肝损伤患者的临床资料进行回顾性分析,采用SPSS 20进行统计学分析处理,两组间的数据比较采用Mann-Whitney U检验,P<0.05具有统计学意义。结果COVID-19患者出现肝损伤的比例为38.5%。107例患者中男53例,女54例,中位年龄57岁;有基础疾病者52例,其中有慢性肝病(包括脂肪肝和病毒性肝炎)者20例(38.5%)。临床表现以发热(86.0%)、咳嗽(92.5%)最常见,部分患者出现恶心呕吐(29.0%)及腹泻(21.5%)等消化道症状。肝功能各检测指标均有不同程度的异常,总胆红素(total bilirubin,TB)升高者占31.8%,丙氨酸氨基转移酶(alanine aminotransferase,ALT)及天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)升高者分别占60.7%和63.6%,分别有86.9%、88.8%、17.8%、7.5%的患者出现血清白蛋白(serum albumin,ALB)、前白蛋白(prealbumin,PAB)、胆碱酯酶(cholinesterase,CHE)、凝血酶原活动度(prothrombin activity,PTA)下降。与轻型或普通型患者相比,重型或危重型患者的TB、ALT、AST水平更高(Z=-2.3089,P=0.037;Z=-2.611,P=0.009;Z=-3.298,P=0.001),而ALB、PAB、CHE下降更明显(Z=5.527,P=0.000;Z=-2.324,P=0.020;Z=-3.119,P=0.002)。合并基础慢性肝病的患者,与无合并基础慢性肝病的患者相比,其ALT、AST升高更明显(Z=-2.218,P=0.027;Z=-1.982,P=0.047)。使用洛匹那韦/利托那韦治疗的患者的TB水平,明显高于未使用洛匹那韦/利托那韦治疗的患者(Z=-3.079,P=0.002)。结论肝功能损伤是COVID-19的常见并发症之一,重型或危重型、合并基础慢性肝病的患者肝损伤较重,临床治疗应注意药物的肝损伤作用。

Objective To investigate the clinical characteristics of the coronavirus disease 2019(COVID-19)with liver injury and to provide evidence for clinical diagnosis and treatment.Methods The clinical data of 107 cases of COVID-19 with liver injury admitted to Guangzhou Eighth People′s Hospital from January 20,2020 to February 17,2020 were retrospectively analyzed.SPSS 20 was used for statistical analysis.Comparison of data between the two groups was performed by Mann-Whitney U test,and P<0.05 was statistically significant.Results The proportion of COVID-19 patients with liver injury was 38.5%.Among the 107 patients,53 were males and 54 were females,with a median age of 57 years.Among the 52 cases with basic diseases,20(38.5%)cases had chronic liver diseases(including fatty liver and viral hepatitis).Patients had clinical manifestations of fever(86.0%),cough(92.5%),nausea and vomiting(29.0%),and diarrhea(21.5%).All the indexes of liver function were abnormal in different degree,31.8%of patients had the total bilirubin(TB)increased,while 60.7%and 63.6%of patients had alanine aminotransferase(ALT)and aspartate aminotransferase(AST)increased respectively.The serum albumin(ALB),prealbumin(PAB),cholinesterase(CHE),prothrombin activity(PTA)decreased in 86.9%,88.8%,17.8%and 7.5%of patients,respectively.The level of TB,ALT,AST was higher in patients with severe or critical disease than in patients with light or common disease(Z=-2.3089,P=0.037;Z=-2.611,P=0.009;Z=-3.298,P=0.001),while ALB,PAB,CHE,PTA decreased more significantly(Z=5.527,P=0.000;Z=-2.324,P=0.020;Z=-3.119,P=0.002).Compared with the patients without basic chronic liver disease,the transaminase of the patients with basic chronic liver disease increased more significantly(Z=-2.218,P=0.027;Z=-1.982,P=0.047).The TB level of patients treated with LPV/r was significantly higher than that of patients without LPV/r(Z=-3.079,P=0.002).Conclusions Liver injury is one of the common complications of COVID-19.Patients in severe or critical condition and with basic chronic liver diseases have severe liver injury.We should pay more attention to the liver injury effect of drugs.