新型冠状病毒肺炎并发肝功能损伤的临床特征  

Clinical characteristics of liver function injury in patients with coronavirus disease 2019

作　　者：赵克开 刘纯[2] 马红英 方晶晶[4] 郑继楠 缪敏[6] 江军 Zhao Kekai;Liu Chun;Ma Hongying;Fang Jingjing;Zheng Jinan;Miao Min;Jiang Jun(Department of Infectious Diseases,The Affiliated Hospital of Medical School of Ningbo University,Ningbo 315020,China;Department of Cardiovascular Surgery,Tongji Hospital,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Respiratory and Critical Care,The Affiliated Hospital of Medical School of Ningbo University,Ningbo 315020,China;Intensive Care Unit,The Affiliated Hospital of Medical School of Ningbo University,Ningbo 315020,China;Emergency Care Unit,The Affiliated Hospital of Medical School of Ningbo University,Ningbo 315020,China;Department of Gastroenterology,The Affiliated Hospital of Medical School of Ningbo University,Ningbo 315020,China)

机构地区：[1]宁波大学医学院附属医院感染科,宁波315020 [2]华中科技大学附属同济医院心血管外科,武汉430030 [3]宁波大学医学院附属医院呼吸与危重科,宁波315020 [4]宁波大学医学院附属医院重症监护病房,宁波315020 [5]宁波大学医学院附属医院急诊监护病房,宁波315020 [6]宁波大学医学院附属医院消化内科,宁波315020

出　　处：《中华传染病杂志》2023年第1期52-57,共6页Chinese Journal of Infectious Diseases

基　　金：浙江省教育厅高校附属医院抗疫专项(Y202043752、Y202043918)。

摘　　要：目的:了解新型冠状病毒肺炎患者肝功能损伤的发生情况,探讨其对病情和预后的影响。方法:收集2020年2月11日至3月28日于华中科技大学附属同济医院住院并诊断为新型冠状病毒感染(COVID-19)且有肺炎表现的67例患者的病历资料,分析患者入院时的肝脏生物化学指标和凝血功能的异常情况。统计学方法采用χ^(2)检验、方差分析和Kruskal-Wallis H检验。结果:67例患者中,7例(10.4%)总胆红素升高,且均为轻度异常;36例(53.7%)白蛋白下降,15例(22.4%)降至30 g/L以下;19例(28.4%)丙氨酸转氨酶(ALT)升高,12例(17.9%)天冬氨酸转氨酶(AST)升高,ALT和(或)AST升高者占32.8%(22/67)。普通型、重型患者ALT和(或)AST升高发生率分别为33.3%(10/30)、26.9%(7/26),11例危重型患者中5例ALT和(或)AST升高,但3组比较差异无统计学意义(χ^(2)=1.21,P=0.546)。碱性磷酸酶和(或)γ-谷氨酰转肽酶异常者占16.4%(11/67)。凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)延长者分别占14.9%(10/67)和25.4%(17/67),但多为轻度异常,只有1例患者PT和APTT延长达到肝衰竭诊断标准。纤维蛋白原和D-二聚体升高者分别占61.2%(41/67)和65.7%(44/67),明显升高者分别占28.4%(19/67)和19.4%(13/67)。普通型、重型、危重型患者的白蛋白分别为(37.85±6.19)、(32.96±4.33)和(33.02±3.63)g/L,差异有统计学意义(F=7.36,P=0.001);3组患者的PT、APTT、纤维蛋白原和D-二聚体差异均有统计学意义(F=3.22、3.31、4.06,H=17.63,均P<0.05)。结论:新型冠状病毒肺炎患者肝损伤较轻,对肝功能的影响较小。白蛋白下降和纤维蛋白原、D-二聚体升高对患者病情严重程度有一定的预警作用。Objective To investigate the incidence of liver injury in patients with coronavirus disease 2019(COVID-19),and to explore its impact on the condition and prognosis of patients.Methods The medical records of 67 patients with COVID-19 who presented with pneumonia hospitalized at Tongji Hospital,Huazhong University of Science and Technology from February 11 to March 28,2020 were collected.The results of liver biochemistry and coagulation function test at admission were analyzed.Data were compared by chi-square test,analysis of variance or Kruskal-Wallis H test.Results Among 67 patients,total bilirubin increased in seven(10.4%)patients,which was slightly abnormal,albumin decreased in 36(53.7%)cases,and was below 30 g/L in 15(22.4%)cases,alanine transaminase(ALT)and aspartate transaminase(AST)were elevated in 19(28.4%)and 12(17.9%)cases,respectively.A total of 22(32.8%)cases had elevated ALT and(or)AST.The incidences with elevated ALT and(or)AST in moderate and severe patients were 33.3%(10/30)and 26.9%(7/26),respectively.Five of 11 critical patients had elevated ALT and(or)AST.There was no significant difference among the three groups(χ^(2)=1.21,P=0.546).Abnormal alkaline phosphatase and(or)γ-glutamyl transpeptidase were observed in 11(16.4%)cases.The prolongation of prothrombin time(PT)and activated partial thromboplastin time(APTT)occurred in 10(14.9%)and 17(25.4%)patients,respectively,while most of them were slightly abnormal.Only one patient presented with prolongation of PT and APTT meeting the standard of liver failure.A total of 61.2%(41/67)and 65.7%(44/67)of cases showed increase of fibrinogen and D-dimer,respectively,and 28.4%(19/67)and 19.4%(13/67),respectively increased to an obvious extent.The albumin levels in moderate,severe and critical patients were(37.85±6.19)g/L,(32.96±4.33)g/L and(33.02±3.63)g/L,respectively,which were significantly different(F=7.36,P=0.001).There were significant differences in PT,APTT,fibrinogen and D-dimer among the three groups(F=3.22,3.31,4.06 and H=17.63,respectively,all

关 键 词：新型冠状病毒肺炎 肝损伤 白蛋白类 血栓形成 抗凝治疗 

分 类 号：R512.99[医药卫生—内科学]