新型冠状病毒感染(COVID-19)流行期间妊娠期肝生化指标异常情况分析

Abnormal liver biochemical parameters in pregnancy during the epidemic of coronavirus disease 2019

目的分析比较新型冠状病毒感染(COVID-19)流行期和非COVID-19流行期孕妇的肝生化指标异常情况。方法回顾性分析2017年10月—2022年3月北京大学第一医院产科出院的肝生化指标ALT、AST、GGT、TBil、总胆汁酸中至少一项异常的孕妇共539例次。按照COVID-19流行期和非流行期两组分析患者的病因、凝血指标、转氨酶、胆汁酸、肾功能。计量资料两组间比较采用独立样本t检验,计数资料两组间比较采用χ^(2)检验。结果非COVID-19流行期产科出院患者中262例次肝生化指标异常,占同期产科出院患者的1.46%,COVID-19流行期为277例次,占比1.73%,差异有统计学意义(χ^(2)=3.947,P=0.047)。两个时期肝生化指标异常患者病因分析提示,四种妊娠期特有肝病(妊娠剧吐、子痫前期和子痫、妊娠期肝内胆汁淤积症、妊娠期急性脂肪肝)的比例,差异均无统计学意义(P值均>0.05)。COVID-19流行期的妊娠肝生化指标异常的患者中肌酐及估算的肾小球滤过率均正常的比例与非COVID-19流行期相比无统计学意义(86.78%vs 87.90%,χ^(2)=0.141,P=0.708)。COVID-19流行期和非流行期ALT达到正常值上限5倍以上的比例分别为7.94%和9.54%(χ^(2)=0.433,P=0.511);重度胆汁淤积(总胆汁酸>40μmol/L)的比例分别为7.75%和9.27%(χ^(2)=0.392,P=0.531),差异均无统计学意义。COVID-19流行期产科出血的比例较非流行期明显下降,分别为14.61%和24.19%(χ^(2)=489.334,P<0.001)。结论COVID-19流行期妊娠期肝生化指标异常的患者中,妊娠期特有肝病的比例较非流行期无差别。COVID-19流行期这些患者中肌酐及估算的肾小球滤过率均正常的比例无变化。

Objective To investigate the differences in abnormal liver biochemical parameters in pregnant patients during the epidemic or non-epidemic period of coronavirus disease 2019(COVID-19).Methods A retrospective analysis was performed for 539 pregnant women who were discharged from Department of Obstetrics,Peking University First Hospital,from October 2017 to March 2022 and had at least one abnormal liver biochemical parameter among alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transpeptidase(GGT),total bilirubin(TBil),and total bile acid.The patients in the epidemic period of COVID-19 and those in the non-epidemic period of COVID-19 were compared in terms of etiology,coagulation parameters,aminotransferases,bile acid,and renal function.The independent samples t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups.Results Among the patients discharged from Department of Obstetrics during the non-epidemic period of COVID-19,262 had abnormal liver biochemical parameters,accounting for 1.46%,while 277 patients had abnormal liver biochemical parameters during the epidemic period of COVID-19,accounting for 1.73%among the patients discharged from Department of Obstetrics during the same period of time,and there was a significant difference between these two groups(χ^(2)=3.947,P=0.047).The etiological analysis of the patients with abnormal liver biochemical parameters during the two periods showed that there was no difference in the proportion of patients with four pregnancy-specific liver diseases(hyperemesis gravidarum,preeclampsia and eclampsia,intrahepatic cholestasis of pregnancy,and acute fatty liver of pregnancy).As for the patients with abnormal liver biochemical parameters in pregnancy,there was no significant difference in the proportion of patients with normal creatinine and stimated glomerular filtration rate(eGFR)between the epidemic period and the non-epidemic period(86.78%vs 87.90%,χ^(2)=0.141,P=0.708).The patients with ALT≥5×upper limit of normal accounted for 7.94%in the epidemic period of COVID-19 and 9.54%in the non-epidemic period(χ^(2)=0.433,P=0.511),and the patients with severe cholestasis accounted for 7.75%in the epidemic period of COVID-19 and 9.27%in the non-epidemic period(χ^(2)=0.392,P=0.531).The proportion of patients with obstetric bleeding during the epidemic period of COVID-19 was significantly lower than that during the non-epidemic period(14.61%vs 24.19%,χ^(2)=489.334,P<0.001).Conclusion There is no difference in the proportion of patients with pregnancy-specific liver diseases among the patients with abnormal liver biochemical parameters in pregnancy between the epidemic period and the non-epidemic period of COVID-19,and there is no change in the proportion of patients with normal creatinine and eGFR among these patients in the epidemic period of COVID-19.