新型冠状病毒肺炎肝功能损害的影响因素分析及其临床意义  

Influencing factors and clinical significance of liver function damage in patients diagnosed with COVID-19

作　　者：孙大伟[1] 张东[2] 田润辉[3] 李洋[4] 王宇石[5] 曹杰[6] 唐颖[7] 张楠[8] 昝涛[2] 高岚[6] 黄燕珠[9] 郑杨[5] 吕国悦[1] Sun Dawei;Zhang Dong;Tian Runhui;Li Yang;Wang Yushi;Cao Jie;Tang Ying;Zhang Nan;Zan Tao;Gao Lan;Huang Yanzhu;Zheng Yang;Lyu Guoyue(Department of Hepatobiliary and Pancreatic Surgery,the First Hospital of Jilin University,Liver Transplantation Center of Jilin University,Changchun 130021,China;Department of Intensive Care Unit,the First Hospital of Jilin University,Changchun 130021,China;Department of Psychology,the First Hospital of Jilin University,Changchun 130021,China;Department of Thoracic Surgery,the First Hospital of Jilin University,Changchun 130021,China;Department of Cardiology,the First Hospital of Jilin University,Changchun 130021,China;Department of Neurology,the First Hospital of Jilin University,Changchun 130021,China;Department of Pulmonary and Critical Care Medicine,the First Hospital of Jilin University,Changchun 130021,China;Department of Gastroenterology,the First Hospital of Jilin University,Changchun 130021,China;Department of Neurology,Sino-French New City Branch of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]吉林大学第一医院肝胆胰外科吉林大学肝移植中心,长春130021 [2]吉林大学第一医院重症医学科,长春130021 [3]吉林大学第一医院心理卫生科,长春130021 [4]吉林大学第一医院胸外科,长春130021 [5]吉林大学第一医院心血管疾病诊治中心,长春130021 [6]吉林大学第一医院神经内科,长春130021 [7]吉林大学第一医院呼吸与危重症医学科,长春130021 [8]吉林大学第一医院胃肠内科,长春130021 [9]华中科技大学同济医学院附属同济医院中法院区神经内科,武汉430030

出　　处：《中华消化外科杂志》2020年第4期360-365,共6页Chinese Journal of Digestive Surgery

基　　金：器官移植与免疫精准医学吉林省重点实验室吉林省科技厅(20180622004JC)。

摘　　要：目的探讨新型冠状病毒肺炎(以下简称新冠肺炎)肝功能损害的影响因素及其临床意义。方法采用回顾性病例对照研究方法。收集2020年2月9—27日吉林大学第一医院第5批援鄂医疗队在华中科技大学同济医学院附属同济医院中法院区收治的51例新冠肺炎患者的临床病理资料;男27例,女24例;平均年龄为68岁,年龄范围为36~86岁。所有患者参照《新型冠状病毒肺炎诊疗方案(试行第六版)》进行治疗。观察指标:(1)患者临床资料。(2)肝功能及肝功能损害治疗情况。(3)肝功能损害影响因素分析。正态分布的计量资料以±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示,组间比较采用χ2检验。采用Logistic回归分析进行单因素分析。结果(1)患者临床资料:51例患者中,新冠肺炎普通型21例,重型19例,危重型11例。31例伴有≥1种慢性疾病史,20例无慢性疾病史;13例有饮酒史,38例无饮酒史;7例有肝炎病史,44例无肝炎病史;入院时5例存在感染性休克,5例合并全身炎症反应综合征(SIRS),41例无休克和SIRS。51例患者体质量指数为(24±3)kg/m2、发病至入院时间为(13±5)d、体温为36.5℃(36.0~38.1℃)、心率为82次/min(50~133次/min)、呼吸频率为20次/min(12~40次/min)。51例患者入院24 h内白细胞计数为6.3×109/L(2.2×109/L^21.7×109/L)、肌酐为75μmol/L(44~342μmol/L),B型钠尿肽为214 ng/L(5~32407 ng/L)。(2)肝功能及肝功能损害治疗情况:51例患者丙氨酸氨基转移酶为31 U/L(7~421 U/L),天冬氨酸氨基转移酶为29 U/L(15~783 U/L),γ-谷氨酰转移酶为36 U/L(13~936 U/L),碱性磷酸酶为76 U/L(41~321 U/L),直接胆红素为4.9μmol/L(2.6~14.3μmol/L),间接胆红素为5.8μmol/L(2.6~23.9μmol/L),活化部分凝血活酶时间为37.2 s(30.9~77.1 s),凝血酶原时间为13.9 s(12.5~26.7 s);51例患者上述指标异常比例分别为47.1%(24/51)、47.1%(24/51)、35.3%(18/51)、13.7%(7/51)、7.8%(4/51Objective To invetigate the influencing factors and clinical significance of liver function damage(LFD)in patients diagnosed with Corona Virus Disease 2019(COVID-19).Methods The retrospective case-control study was conducted.The clinicopathological data of 51 patients with COVID-19 who were admitted to the Sino-French New City Branch of Tongji Hospital Affiliated to Huazhong University of Science and Technology by the 5th group assisting team from the First Hospital of Jilin University from February 9th to 27th in 2020 were collected.There were 27 males and 24 females,aged from 36 to 86 years,with an average age of 68 years.The treatment modality was according to the diagnostic and therapeutic guideline for COVID-19(Trial 6th edition)issued by National Health Commission.Observation indicators:(1)clinical data of patients;(2)analysis of liver function index and treatment of LFD;(3)analysis of influencing factors for LFD.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were described as M(range).Count data were described as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test.The Logistic regression method was used for univariate analysis.Results(1)Clinical data of patients:of the 51 patients,21 were classified as ordinary type of COVID-19,19 as severe type and 11 as critical type.In terms of medical history,31 patients suffered from more than or equal to one kind of chronic disease,20 had no history of chronic disease.Thirteen patients had the drinking history and 38 had no drinking history.Seven patients were hepatitis positive and 44 were hepatitis negative.Five patients had septic shock at admission,5 had systemic inflammatory response syndrome(SIRS),and 41 had neither shock nor SIRS.The body mass index(BMI),time from onset to admission,temperature,heart rate,respiratory rate of the 51 patients were(24±3)kg/m2,(13±5)days,36.5℃(range,36.0-38.1℃),82 times/minutes(range,50-133 times/minutes),20

关 键 词：新型冠状病毒肺炎 肝功能 肝功能损害 临床分型 呼吸衰竭 影响因素 

分 类 号：R563.1[医药卫生—呼吸系统] R575[医药卫生—内科学]