Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-cho, Iruma-Gun, Saitama, 350-0495, Japan.
Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan.
J Gastroenterol. 2020 Nov;55(11):1098-1106. doi: 10.1007/s00535-020-01717-4. Epub 2020 Aug 9.
COVID-19 has emerged as a threat to human health. Liver dysfunction has been reported to occur frequently in patients with COVID-19, although its significance has not yet been elucidated.
The subjects were 35 patients with COVID-19, and clinical characteristics were retrospectively analyzed. COVID-19 patients requiring ventilator were classified as having severe COVID-19.
All 35 patients were diagnosed as having mild-to-moderate COVID-19 at admission, but the severity aggravated to severe in 8 patients (22.9%) in hospital. Hepatocellular-type liver injury, defined as elevation of the serum AST and/or ALT levels to ≥ 3 times the ULN, was seen in 2 patients (5.7%), and cholestasis-type liver injury, defined as elevation of the serum ALP, γ-GTP and/or total bilirubin levels to ≥ twice the ULN, was seen in 4 patients (11.4%). A total of 9 patients (25.7%) fulfilled the criteria for liver injury. The percentage of patients with liver injury was higher in patients with severe COVID-19 than in the remaining patients (P = 0.001). Both the hepatic CT attenuation values and the liver-to-spleen attenuation (L/S) ratios at admission were lower in the former patients than in the latter patients (P < 0.001). ROC curve revealed the optimal cut-off value of the L/S ratio of 1.03 for discriminating between patients with severe and non-severe diseases. The hepatic CT attenuation values increased at the remission phase of the disease as compared to the values at admission (P = 0.012).
Liver dysfunction associated with reduced hepatic CT attenuation values correlated with the disease severity in patients with COVID-19.
COVID-19 已成为人类健康的威胁。虽然 COVID-19 患者经常发生肝功能异常，但尚未阐明其意义。
本研究共纳入 35 例 COVID-19 患者，回顾性分析其临床特征。需要呼吸机的 COVID-19 患者被归类为重症 COVID-19。
所有 35 例患者入院时均被诊断为轻中度 COVID-19，但在住院期间有 8 例（22.9%）患者病情加重至重症。2 例（5.7%）患者出现肝细胞型肝损伤，定义为血清 AST 和/或 ALT 水平升高至 ULN 的 3 倍以上；4 例（11.4%）患者出现胆汁淤积型肝损伤，定义为血清 ALP、γ-GTP 和/或总胆红素水平升高至 ULN 的 2 倍以上。共有 9 例（25.7%）患者符合肝损伤标准。重症 COVID-19 患者的肝损伤发生率高于非重症患者（P=0.001）。与后者相比，前者患者入院时的肝脏 CT 衰减值和肝脾 CT 衰减比值（L/S）均较低（P<0.001）。ROC 曲线显示，L/S 比值为 1.03 时，区分重症和非重症患者的最佳截断值。与入院时相比，疾病缓解期患者的肝脏 CT 衰减值增加（P=0.012）。
与 COVID-19 患者疾病严重程度相关的肝功能异常与肝脏 CT 衰减值降低有关。
