COVID-19 住院患者的肝功能生化指标。

Liver Biochemistries in Hospitalized Patients With COVID-19.

机构信息

Division of GastroenterologyDepartment of MedicineMassachusetts General HospitalBostonMA.

Department of MedicineHarvard Medical SchoolBostonMA.

出版信息

Hepatology. 2021 Mar;73(3):890-900. doi: 10.1002/hep.31326. Epub 2020 Nov 4.

DOI:10.1002/hep.31326

PMID:32415860

Abstract

BACKGROUND AND AIMS

Coronavirus disease 2019 (COVID-19) leads to elevated liver biochemistries in approximately half of patients on presentation. To date, data are limited regarding the trend of liver biochemistries over the course of illness. We aimed to evaluate the trend, etiology, and outcomes associated with liver biochemistries in COVID-19.

APPROACH AND RESULTS

A total of 60 patients with COVID-19 were admitted between March 21 and March 28, 2020. The mean age was 57 years, 65% were male, and 28% were Hispanic. At the study conclusion, 6 patients were deceased, 28 were discharged, and 26 remained admitted. Patients who remained admitted were followed for a median of 12 days. Of 60 patients, 41 (69%) had at least one abnormal liver biochemistry on admission. Median aspartate aminotransferase (AST) was higher than alanine aminotransferase (ALT) at admission (46 vs. 30 U/L) and during the hospital course. Aminotransferases rose above normal in 54 (93%) patients, whereas alkaline phosphatase and total bilirubin elevations were rare. Ten (17%) patients developed aminotransferases more than 5 times the upper limit of normal. AST highly correlated with ALT throughout the illness course (r = 0.97; P < 0.0001), whereas correlations with markers of muscle injury and inflammation were weak. Statin use was common before (40%) and during admission (80%) at our center, with no difference in peak liver biochemistries between users and nonusers. No demographic or comorbid illness was associated with liver injury. Admission AST (69 vs. 49; P < 0.05), peak AST (364 vs. 77; P = 0.003), and peak ALT (220 vs. 52; P = 0.002) were higher in intubated patients.

CONCLUSIONS

AST-dominant aminotransferase elevation is common in COVID-19, mirrors disease severity, and appears to reflect true hepatic injury.

摘要

背景和目的

新冠肺炎（COVID-19）患者在就诊时约有一半会出现肝生化指标升高。迄今为止，有关疾病过程中肝生化指标变化趋势的数据有限。本研究旨在评估 COVID-19 患者肝生化指标的变化趋势、病因和结局。

方法和结果

2020 年 3 月 21 日至 3 月 28 日期间，共收治 60 例 COVID-19 患者。患者平均年龄为 57 岁，65%为男性，28%为西班牙裔。研究结束时，6 例患者死亡，28 例患者出院，26 例患者仍住院。仍住院的患者中位随访时间为 12 天。60 例患者中，41 例（69%）入院时至少有一项肝生化指标异常。入院时（46 比 30 U/L）和住院期间，天冬氨酸转氨酶（AST）高于丙氨酸转氨酶（ALT）。54 例（93%）患者的转氨酶升高超过正常值，碱性磷酸酶和总胆红素升高则少见。10 例（17%）患者的转氨酶升高超过正常值上限的 5 倍。AST 在整个疾病过程中与 ALT 高度相关（r=0.97；P<0.0001），而与肌肉损伤和炎症标志物的相关性较弱。在我们中心，他汀类药物在入院前（40%）和入院期间（80%）的使用都很常见，但使用者和非使用者的肝生化指标峰值没有差异。没有发现与肝损伤相关的人口统计学或合并症。入院时 AST（69 比 49；P<0.05）、峰值 AST（364 比 77；P=0.003）和峰值 ALT（220 比 52；P=0.002）在插管患者中更高。