Yao N, Wang S N, Lian J Q, Sun Y T, Zhang G F, Kang W Z, Kang W
Department of Infectious Diseases, Tangdu Hospital, the Air Force Medical University, Xi'an 710038, China.
Zhonghua Gan Zang Bing Za Zhi. 2020 Mar 20;28(3):234-239. doi: 10.3760/cma.j.cn501113-20200226-00070.
To understand the clinical characteristics, change of liver function, influencing factors and prognosis in hospitalized patients with coronavirus disease-19 (COVID-19) combined with liver injury. The general conditions, biochemical indicators of liver, blood clotting mechanism, routine blood test, UGT1A1 * 28 gene polymorphism and other data of 40 cases with COVID-19 admitted to the isolation ward of Tangdu Hospital were retrospectively analyzed. The clinical characteristics, influencing factors and prognosis of liver injury in patients with liver injury group and those with normal liver function group were compared. The mean of two samples in univariate analysis was compared by t-test and analysis of variance. The counting data was measured by χ(2) tests. The non-normal distribution measurement data were described by the median, and the non-parametric test was used. Statistically significant influencing factors were used as the independent variables in univariate analysis. Multiple logistic regression analysis was used to analyze the main influencing factors of liver injury. Of the 40 cases, 25 were male (62.5%) and 15 were female (37.5%), aged 22 to 83 (53.87 ± 15.84) years. Liver injury was occurred in 22 cases (55%) during the course of the disease. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) level was initially increased (4.4 to 3.5 times of the normal value) along with decrease of albumin in the second week, and the difference was statistically significant ( < 0.001). Ten cases (43.5%) had highest abnormal total blood bilirubin (54.1 μmol/ L). There was no correlation between the increase in transaminase and the increase in total blood bilirubin ( = -0.006, = 0.972). Three cases had prothrombin activity (PTA) of ≤50%, 10 cases had elevated FDP, and 13 cases had elevated D-dimer, all of whom were severe or critically ill. Liver function injury was more likely to occur in patients who used many types of drugs and large amounts of hormones ( = 0.002, = 0.031), and there was no correlation with the TA6TA7 mutation in the UGT1A1 * 28 gene locus. Multiple regression analysis showed that the occurrence of liver injury was only related to critical illness. The liver function of all patients had recovered within one week after conventional liver protection treatment. COVID-19 combined with liver function injury may be due to the slight elevation of transaminase, mostly around the second week of the disease course. Severe patients have a higher proportion of liver injury, and critical type is an independent risk factor for liver injury.
了解新型冠状病毒肺炎（COVID-19）合并肝损伤住院患者的临床特征、肝功能变化、影响因素及预后。回顾性分析唐都医院隔离病房收治的40例COVID-19患者的一般情况、肝脏生化指标、凝血机制、血常规、UGT1A128基因多态性等资料。比较肝损伤组和肝功能正常组患者肝损伤的临床特征、影响因素及预后。单因素分析中两组样本均数比较采用t检验和方差分析。计数资料采用χ²检验。非正态分布的计量资料用中位数描述，采用非参数检验。将单因素分析中有统计学意义的影响因素作为自变量，采用多因素logistic回归分析肝损伤的主要影响因素。40例患者中，男性25例（62.5%），女性15例（37.5%），年龄22～83（53.87±15.84）岁。病程中发生肝损伤22例（55%）。丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）水平最初升高（为正常值的4.4～3.5倍），第2周白蛋白下降，差异有统计学意义（<0.001）。10例（43.5%）总胆红素异常最高（54.1μmol/L）。转氨酶升高与总胆红素升高无相关性（r=-0.006，P=0.972）。3例凝血酶原活动度（PTA）≤50%，10例纤维蛋白降解产物（FDP）升高，13例D-二聚体升高，均为重症或危重症患者。使用多种药物及大量激素的患者更容易发生肝功能损伤（P=0.002，P=0.031），与UGT1A128基因位点TA6TA7突变无相关性。多因素回归分析显示，肝损伤的发生仅与危重症有关。所有患者经常规保肝治疗1周内肝功能均恢复。COVID-19合并肝功能损伤可能表现为转氨酶轻度升高，多在病程第2周左右出现。重症患者肝损伤比例较高，危重型是肝损伤的独立危险因素。
