新型冠状病毒肺炎患者中医药治疗与肝损伤发生相关性的回顾性分析  

Retrospective Analysis of Correlation between Traditional Chinese Medicine Treatment and Liver Injury in Coronavirus Disease 2019(COVID-19)

作　　者：刘遥[1] 江宇泳[1] 王宪波[1] LIU Yao;JIANG Yuyong;WANG Xianbo(Beijing Ditan Hospital,Capital Medical University,Beijing,100015)

机构地区：[1]首都医科大学附属北京地坛医院,北京100015

出　　处：《中医杂志》2022年第14期1362-1367,共6页Journal of Traditional Chinese Medicine

摘　　要：目的分析新型冠状病毒肺炎(简称新冠肺炎)患者发生肝损伤的影响因素,并进一步分析是否接受中医药治疗的患者在肝损伤方面存在的差异。方法回顾性纳入入院时肝功能指标正常的390例新冠肺炎患者,收集患者基线特征指标,包括年龄、性别、基础肝病、合并症、中药治疗情况、免疫和炎症相关指标、血常规、肾小球滤过率及凝血、肝功能等指标,判断住院期间患者的药物性肝损伤情况,采用Cox回归分析确定患者肝损伤相关的危险因素。再将入组患者根据用药情况分为中药治疗组(288例)及非中药治疗组(102例)。分别于入院时(治疗0天)和治疗3、7、10、14天检测患者的肝功能指标,包括丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)和白蛋白(ALB)水平。结果住院期间有179例患者发生肝损伤。Cox回归分析显示,年龄(P=0.001)、CD4+T细胞计数(P=0.009)和血清淀粉样蛋白A(P=0.014)是影响新冠肺炎患者肝损伤发生的独立影响因素,而中药治疗与肝损伤发生无相关性(P=0.287)。中药治疗组及非中药治疗组患者基线数据比较,乳酸、中性粒细胞计数、淋巴细胞计数、单核细胞计数、中性粒细胞计数/淋巴细胞计数和血小板平均分布宽度的差异具有统计学意义(P<0.05或P<0.01),故将上述存在统计学差异的6个变量纳入1∶1倾向评分匹配(89对,共178例),匹配后两组患者基线数据差异无统计学意义。经倾向评分匹配后,两组肝功能指标ALT、TBIL和ALB差异均无统计学意义(P>0.05),而治疗3天时中药治疗组AST水平明显低于非中药治疗组(P=0.036)。ALT、AST、TBIL及ALB在不同时间组内差异均有统计学意义(P<0.001)。倾向匹配前后两组患者相比,ALT、AST和TBIL异常的人数差异无统计学意义(P>0.05)。结论年龄、CD4+T细胞计数和血清淀粉样蛋白A是影响新冠肺炎患者发生肝损伤的潜在独立影响因素,�Objective2019(COVID-19)and to further analyze the correlation between traditional Chinese medicine(TCM)treatment and liver injury.Methods spectively collected including baseline characteristics such as age,gender,underlying liver disease and comorbidities,TCM treatment,immune and inflammation-related indicators,blood routine,glomerular filtration rate and coagulation,liver function and other indicators.The drug-induced liver injury during hospitalization was assessed,and Cox regression analysis was used to determine the risk factors related to liver injury.Participants were assigned into the TCM(288 cases)and non-TCM(102 cases)groups.The liver function indicators including alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),and albumin(ALB)were detected at admission(day 0 during treatment)and after 3-,7-,10-,and 14-day treatment.ResultsThere were 179 cases of liver injury during hospitalization.Cox regression analysis showed that age(P=0.001),CD4+T cells(P=0.009)and serum amyloid A(P=0.014)were independently associated with the occurrence of liver injury in COVID-19 patients,while the use of TCM treatment was not(P=0.287).Regarding the baseline data,there were significant differences in lactate,neutrophil count,lymphocyte count,monocyte count,ratio of neutrophil count and lymphocyte count,and platelet mean distribution width between TCM group and non-TCM group(P0.05).After PSM,liver function indexes including ALT,TBIL and ALB were not significant different between TCM group and non-TCM group after 3-,7-,10-,and 14-day treatment(P>0.05).However,The AST level of the TCM group was significantly lower than that of the non-TCM group after 3-day treatment(P=0.036).There was no significant difference in the number of patients with abnormal ALT,AST and TBIL after 3-,7-,10-,and 14-day treatment(P<0.001).Conclusion COVID-19 patients.TCM treatment has not yet been found to increase the incidence of liver injury in patients with COVID-19.

关 键 词：新型冠状病毒肺炎 肝损伤 肝功能 影响因素 中医药疗法 

分 类 号：R259[医药卫生—中西医结合]