Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Clin Gastroenterol Hepatol. 2021 Mar;19(3):597-603. doi: 10.1016/j.cgh.2020.06.017. Epub 2020 Jun 15.
BACKGROUND & AIMS: Coronavirus disease 2019 (COVID-19) is a major global health threat. We aimed to describe the characteristics of liver function in patients with SARS-CoV-2 and chronic hepatitis B virus (HBV) coinfection.
We enrolled all adult patients with SARS-CoV-2 and chronic HBV coinfection admitted to Tongji Hospital from February 1 to February 29, 2020. Data of demographic, clinical characteristics, laboratory tests, treatments, and clinical outcomes were collected. The characteristics of liver function and its association with the severity and prognosis of disease were described.
Of the 105 patients with SARS-CoV-2 and chronic HBV coinfection, elevated levels of liver test were observed in several patients at admission, including elevated levels of alanine aminotransferase (22, 20.95%), aspartate aminotransferase (29, 27.62%), total bilirubin (7, 6.67%), gamma-glutamyl transferase (7, 6.67%), and alkaline phosphatase (1, 0.95%). The levels of the indicators mentioned above increased substantially during hospitalization (all P < .05). Fourteen (13.33%) patients developed liver injury. Most of them (10, 71.43%) recovered after 8 (range 6-21) days. Notably the other, 4 (28.57%) patients rapidly progressed to acute-on-chronic liver failure. The proportion of severe COVID-19 was higher in patients with liver injury (P = .042). Complications including acute-on-chronic liver failure, acute cardiac injury and shock happened more frequently in patients with liver injury (all P < .05). The mortality was higher in individuals with liver injury (28.57% vs 3.30%, P = .004).
Liver injury in patients with SARS-CoV-2 and chronic HBV coinfection was associated with severity and poor prognosis of disease. During the treatment of COVID-19 in chronic HBV-infected patients, liver function should be taken seriously and evaluated frequently.
2019 年冠状病毒病（COVID-19）是一项重大的全球健康威胁。本研究旨在描述 SARS-CoV-2 与慢性乙型肝炎病毒（HBV）合并感染患者的肝功能特征。
我们纳入了 2020 年 2 月 1 日至 2 月 29 日期间因 SARS-CoV-2 和慢性 HBV 合并感染而入住同济医院的所有成年患者。收集了人口统计学、临床特征、实验室检查、治疗和临床结局的数据。描述了肝功能的特征及其与疾病严重程度和预后的关系。
在 105 例 SARS-CoV-2 和慢性 HBV 合并感染患者中，入院时部分患者的肝功能检查指标升高，包括丙氨酸氨基转移酶（22 例，20.95%）、天冬氨酸氨基转移酶（29 例，27.62%）、总胆红素（7 例，6.67%）、γ-谷氨酰转移酶（7 例，6.67%）和碱性磷酸酶（1 例，0.95%）升高。住院期间上述指标的水平显著升高（均 P <.05）。14 例（13.33%）患者发生了肝损伤。其中大多数（10 例，71.43%）在 8 天（6-21 天）后恢复。值得注意的是，另外 4 例（28.57%）患者迅速发展为慢加急性肝衰竭。肝损伤患者的 COVID-19 重型比例较高（P =.042）。肝损伤患者发生急性慢加急性肝衰竭、急性心脏损伤和休克等并发症的比例较高（均 P <.05）。肝损伤患者的死亡率较高（28.57%比 3.30%，P =.004）。
SARS-CoV-2 与慢性 HBV 合并感染患者的肝损伤与疾病的严重程度和不良预后有关。在治疗慢性 HBV 感染患者的 COVID-19 时，应重视并经常评估肝功能。
