新型冠状病毒奥密克戎变异株感染者肝损伤特征及其影响因素分析  

Liver function injury in patients with omicron variant COVID-19 and its influencing factors

作　　者：丁丰 孟泽露 孟依娜 王剑钢 应玲玲 谢晓青 俞亚峰 杨益大[2] 沈华江 Ding Feng;Meng Zelu;Meng Yina;Wang Jiangang;Ying Lingling;Xie Xiaoqing;Yu Yafeng;Yang Yida;Shen Huajiang(Department of Infectious Diseases,the Afiliated Hospital of Shaoxing University,Shaoxing 312000,Zhejiang Province,China;Department of Infectious Diseases,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China)

机构地区：[1]绍兴文理学院附属医院感染性疾病学科,绍兴312000 [2]浙江大学医学院附属第一医院感染病科,杭州310003

出　　处：《中华临床感染病杂志》2023年第5期360-366,共7页Chinese Journal of Clinical Infectious Diseases

基　　金：绍兴市级医卫类科技计划项目(2020A13101)。

摘　　要：目的:分析新型冠状病毒奥密克戎(Omicron)变异株感染者肝损伤的临床特征及其影响因素。方法:收集2022年2月23日至7月14日在浙江省确诊感染Omicron变异株患者的流行病学、临床症状、实验室检查,以及治疗转归的资料,并进行回顾性分析。根据肝功能指标分为肝损伤组和无肝损伤组,比较两组临床特征和实验室指标的差异,并分析肝损伤的影响因素。采用SPSS 26.0统计软件进行数据分析。结果:共纳入Omicron变异株感染者897例,其中肝损伤组243例,无肝损伤组654例。肝损伤的发生比例为27.09%。肝损伤组患者的年龄更大,体质指数更高(Z=-6.237和-2.166,P<0.05),合并高血压、糖尿病的比例,以及临床重型比例高于无肝损伤组(χ^(2)=17.087、27.509和12.945,P<0.01),但肝损伤组疫苗接种的比例更低(χ^(2)=17.766,P<0.01)。肝损伤组患者血小板、血红蛋白、白蛋白和血钾水平低于无肝损伤组(Z=-4.631、-2.368、-10.593和-2.141,P<0.05),而丙氨酸转氨酶、天冬氨酸转氨酶、谷氨酰转肽酶、血尿素氮、血糖和超敏C-反应蛋白(CRP)水平高于无肝损伤组(Z=-7.451、-8.663、-4.410、-3.824、-3.278和-3.884,P<0.01)。多因素Logistic回归分析发现,年龄(OR=2.580,95%CI 1.429~4.657,P=0.002)、合并糖尿病(OR=3.650,95%CI 1.698~7.849,P=0.001)、血红蛋白降低(OR=1.993,95%CI 1.066~3.726,P=0.031)和超敏CRP升高(OR=1.797,95%CI 1.283~2.517,P=0.001)是肝损伤相关的危险因素,疫苗接种(OR=0.499,95%CI 0.312~0.798,P=0.004)是肝损伤相关的保护因素。结论:Omicron变异株感染者肝损伤较常见,与年龄、基础疾病和炎症指标升高等有关,而疫苗接种可减少感染患者肝损伤的风险。因此,在COVID-19相关肝损伤的预防和治疗中,可加强老年及合并基础疾病等患者肝功能相关指标的检测,并提倡完善新型冠状病毒疫苗的接种。ObjectiveTo analyze the incidence of liver function injury in patients infected with 2019-nCoV omicron variant and its influencing factors.Methods The clinical data and laboratory findings of 897 COVID-19 patients infected with omicron variant in Zhejiang province from February 23 to July 14,2022 were retrospectively analyzed.Patients were divide into liver function injury group(n=243)and non-liver function injury group(n=654)based on liver function indicators.The clinical characteristics and laboratory tests were compared between the two groups,and influencing factors of liver function injury were analyzed.SPSS 26.0 statistical software was used for data analysis.Results The incidence of liver injury in this series was 27.09%(243/897).The median age of patients in liver injury group was older,the body mass index(BMI)was higher(Z=-6.237 and-2.166,both P<0.05),the proportions of patients with hypertension and diabetes,and with severe clinical classification were higher(X^(2)=17.087,27.509 and 12.945,all P<0.01);the proportion of vaccinated patients was lower(X^(2)=17.766,P<0.01)than those in non-liver injury group.The levels of platelet,hemoglobin,albumin and potassium in liver injury group were lower than those in non-liver injury group(Z=-4.631,-2.368,-10.593 and-2.141,all P<0.05),while serum ALT,AST,-GT,urea nitrogen,glucose and hs-CRP levels were higher than those in the non-liver injury group(Z=-7.451,-8.663,-4.410,-3.824,-3.278 and-3.884,all P<0.01).Multivariate Logistic regression analysis showed that age(0R=2.580,95%CI 1.429-4.657,P=0.002),history of diabetes(0R=3.650,95%CI 1.698-7.849,P=0.001),and decreased hemoglobin(OR=1.993,95%CI 1.066-3.726,P=0.031)and increased hs-CRP(OR=1.797,95%CI 1.283-2.517,P=0.001)were risk factors associated with liver function injury,while vaccination(0R=0.499,95%CI 0.312-0.798,P=0.004)was the protective factor for liver function.Conclusion Liver function injury is frequently observed in COVID-19 patients infected with omicron variant,which is linked to age,underlying disease,

关 键 词：新型冠状病毒感染 奥密克戎 肝损伤 影响因素 

分 类 号：R511[医药卫生—内科学] R575[医药卫生—临床医学]