儿童与成人新型冠状病毒肺炎Delta毒株合并肝损伤特征分析  

Characteristics of liver injury associated with COVID-2019 Delta strain in children and adults

作　　者：刘娜[1] 王东芳[1] 陈静[1] 吴凤娟 李彩 陈佩[1] LIU Na;WANG Dongfang;CHEN Jing;WU Fengjuan;LI Cai;CHEN Pei(Department of Gastroenterology,the First People's Hospital of Zhengzhou,Zhengzhou,Henan 450000,China)

机构地区：[1]郑州市第一人民医院消化内科,河南郑州450000

出　　处：《中国医学工程》2023年第5期65-68,共4页China Medical Engineering

基　　金：河南省医学科技攻关计划项目(LHGJ20200699)。

摘　　要：目的探讨新型冠状病毒肺炎(COVID-2019)Delta毒株患者合并肝损伤的临床特征及影响因素。方法纳入2021年11月至12月河南省新型冠状病毒(SARS-CoV-2)定点收治医院确诊的Delta毒株新型冠状病毒肺炎79例患者。按照肝功能状态及年龄,将病例分为肝功能异常组(n=16)和肝功能正常组(n=63)、儿童组(n=50)和成人组(n=29),检测丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、谷氨酰转肽酶(GGT)、总胆红素(TBIL)、乳酸脱氢酶(LDH)、白细胞、C-反应蛋白(CRP)、淋巴细胞计数、总T淋巴细胞计数、辅助/诱导T淋巴细胞计数(CD4^(+)T)、白介素6(IL-6)、肌酸激酶同工酶(CK-MB)、肌酐(Cr)及Delta毒株核酸Ct值等水平,两组计量资料比较,不符合正态分布的采用非参数检验(秩和检验);计数资料采用Fisher精确概率检验。总结分析COVID-2019 Delta毒株合并肝损伤的原因及特征。结果与肝功能正常组相比,肝功能异常组患者淋巴细胞计数、总T淋巴细胞计数均显著减少(P<0.05);儿童组肝功能异常率明显低于成人组(P<0.05),但儿童组肝功能指标LDH则高于成人组(P<0.05);各组间患者鼻咽拭子SARS-CoV-2 Delta毒株核酸Ct值比较,差异均无统计学意义(P>0.05)。结论COVID-2019 Delta毒株感染患者在各年龄段均会出现不同程度肝损伤,其中淋巴细胞及T淋巴细胞计数减少与肝损伤发生密切相关,在轻型及普通型患者中儿童组肝功能异常率低于成人组,肝功能指标LDH水平可作为评估儿童早期肝损伤的重要依据。【Objective】To investigate the clinical characteristics and influencing factors of new coronavirus(SARS-COV-2)Delta patients with liver injury.【Methods】Seventy-nine cases of new coronavirus pneumonia,diagnosed with Delta were collected in the Designated Hospital of novel coronavirus(SARS-CoV-2)in Henan Province from November 2021 to December 2021.According to the state and age of liver function,the patients were divided into abnormal liver function group(n=16)and normal liver function group(n=63),children group(n=50)and adult group(n=29).The levels of ALT,AST,GGT,TBIL,lactate dehydrogenase(LDH),leukocyte,CRP,lymphocyte count,total T lymphocyte count,CD4^(+)T,IL6,CK-MB,Cr and delta strain nucleic acid Ct were measured and compared between the two groups.Nonparametric test(rank sum test)is used if it does not conform to the normal distribution,and the counting data were tested by Fisher exact probability test.The causes and characteristics of COVID-2019 Delta strain complicated with liver injury were summarized and analyzed.【Results】Compared with the normal liver function group,the lymphocyte count and total T lymphocyte count in the abnormal liver function group decreased significantly(P<0.05).The abnormal rate of liver function in children group was significantly lower than that in adult group(P<0.05),but the index of liver function(LDH)in children group was higher than that in adult group(P<0.05).There was no significant difference in the nucleic acid Ct value of SARS-CoV-2 delta strain in nasopharyngeal swabs between groups.【Conclusion】There are different degrees of liver damage in all age groups of COVID-2019 Delta infected patients.The decrease of lymphocyte and T lymphocyte counts is closely related to the occurrence of liver injury.In light and ordinary patients,the abnormal rate of liver function in children group is lower than that in adult group.The LDH level of liver function index can be used as an important basis for evaluating early liver injury in children.

关 键 词：新型冠状病毒肺炎 肝损伤 儿童 Delta毒株 

分 类 号：R563.1[医药卫生—呼吸系统] R512.99[医药卫生—内科学]