非危重型新型冠状病毒感染患者的消化系统症状及其与抗病毒药物应用的关系  

Digestive symptoms and their correlation with antiviral drugs in non-critical coronavirus disease 2019 patients

作　　者：陈小华 罗威[2] 张瑞珍[3] 王光辉 张红霞 李耀军[3] 李利安[1] Chen Xiaohua;Luo Wei;Zhang Ruizhen;Wang Guanghui;Zhang Hongxia;Li Yaojun;Li Li’an(Department of Gastroenterology,the Central Hospital of Luohe,Luohe 462000,China;Department of General Surgery,the Central Hospital of Luohe,Luohe 462000,China;Department of Respiratory and Critical Care Medicine,the Central Hospital of Luohe,Luohe 462000,China;Infectious Diseases Hospital,Luohe 462000,China)

机构地区：[1]河南省漯河市中心医院消化内科,462000 [2]河南省漯河市中心医院普外科,462000 [3]河南省漯河市中心医院呼吸与危重症医学科,462000 [4]河南省漯河市传染病医院,462000

出　　处：《临床医学》2020年第11期11-14,共4页Clinical Medicine

摘　　要：目的分析非危重型新型冠状病毒感染(coronavirus disease 2019,COVID-19)患者的消化系统症状表现及其与抗病毒药物应用的关系。方法回顾性分析2020年1月23日至2月14日漯河市收治的24例非危重型COVID-19患者的年龄、性别、病史、实验室检查、临床表现,尤其是消化系统症状,用药情况,出院随访等资料,并以发病时间标准化。结果 24例患者中男19例,女5例;年龄7~69岁,中位年龄42岁;住院时间9~36 d,中位住院时间:18 d;轻型1例,普通型16例,重型7例。发病初期:4例(16.7%,4/24)患者出现消化道症状,以食欲不振为主;治疗过程中出现腹泻14例(58.3%,14/24),恶心(54.2%,13/24) 13例,呕吐5例(20.8%,5/24),反酸、烧心4例(16.7%,4/24),明显腹痛及腹胀各2例(8.3%,2/24),腹泻、恶心症状出现在应用洛匹那韦/利托那韦和磷酸奥司他韦后。12例(50.0%,12/24)患者出现丙氨酸氨基转移酶升高,5例(20.8%,5/24)天门冬氨酸氨基转移酶升高,4例(16.7%)谷氨酰转移酶升高。12例肝酶升高患者中,5例(41.7%,5/12)应用三种及以上抗病毒药物;2例(16.7%,2/12)肝酶经治疗正常后,后期再次升高。结论非危重型COVID-2019患者的消化道症状在发病初期较少见,但抗病毒药物相关性消化系统症状及肝损伤明显,应引起重视。Objective To analyze the digestive symptoms in laboratory-confirmed patients with non-critical coronavirus disease 2019( COVID-19) and their relationship with antivirus drugs.Methods The clinical data of age,gender,history,laboratory examination,manifestations,especially digestive symptoms,medication,and the follow-up data of 24 non-critical COVID-19 patients admitted to Luohe were retrospectively analyzed. And data were standardized by both the onset day and the admission day. Results Among the 24 patients,19 patients were males and 5 patients were females,with a median age of 42( 7-69) years old. Median length of stay: 18( 9-36) days. There were 1 case of mild case,16 cases of conventional cases and 7 cases of severe cases. Four patients( 16. 7%) had anorexia at early onset;during the antiviral treatment: 58. 3%( 14/24) cases had diarrhea,54. 2%( 13/24) cases developed nausea,vomiting occurred in 5 cases,acid reflux or heartburn in 4 cases,obvious abdominal pain in 2 cases,abdominal distension in 2 cases. Diarrhea and nausea developed after the administration of lopinavir/ritonavir and oseltamivir phosphate. ALT increased in 12 patients( 50. 0%),AST increased in 5 patients( 20. 8%) and GGT increased in 4 patients( 16. 7%). Five of twelve( 41. 7%) with abnormal liver function received three or more antiviral drugs. Liver enzymes normalized in two patients were raised again during the later of the treatment. Conclusions The gastrointestinal symptoms of noncritical COVID-2019 patients are rare in the early onset,but the antiviral drugs induced digestive side effect and liver injury are obvious during the treatment,which should be given enough attention.

关 键 词：新型冠状病毒感染疾病-19 非危重型 消化系统 抗病毒药物 不良反应 药物性肝损伤 

分 类 号：R563.1[医药卫生—呼吸系统]