Gao Yuan, Li Qi, Shi Hongbo, Feng Yingmei, Zhang Tong, Chen Yu, Liang Lianchun, Chen Dexi, Wu Hao, Jin Ronghua, Huang Xiaojie
Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.
Department of Hepatology and Gastroenterology, Beijing Youan Hospital, Capital Medical University, Beijing, China.
Front Med (Lausanne). 2020 Aug 7;7:501. doi: 10.3389/fmed.2020.00501. eCollection 2020.
Abnormal liver function is a common indication of coronavirus disease 2019 (COVID-19) patients. Two proposed mechanisms are liver injury mediated by angiotensin-converting enzyme 2 (ACE2) and the involvement of the systemic immune response. We investigated the role played by these to determine the cause of liver abnormality in the early stages of COVID-19. A cross-sectional study was conducted among confirmed cases of COVID-19 at Beijing Youan Hospital from January 21, 2020, to February 24, 2020. We compared clinical characteristics, viremia status, and cytokine profile on admission between patients with and without liver disorder. Of the 44 COVID-19 patients analyzed, there were no differences in the clinical symptoms and signs, disease severity, or computed tomography (CT) image features between the two groups. Lymphopenia was more common in the liver disorder group. Further, C-reactive protein levels were much higher in the hepatic disorder group, with significantly higher concentrations of IL-6, IL-10, and M-CSF. Viremia was detected in only 7% of patients. Due to the infrequency of viremia, ACE2-mediated viral hepatitis does not seem to account for the commonly observed liver disorders in COVID-19 patients. By contrast, a dysregulated immune response may be a crucial pathogenic factor for liver disorder in the early stages of COVID-19.
肝功能异常是2019冠状病毒病（COVID-19）患者的常见表现。两种提出的机制是血管紧张素转换酶2（ACE2）介导的肝损伤和全身免疫反应的参与。我们研究了这些因素所起的作用，以确定COVID-19早期肝异常的原因。2020年1月21日至2月24日，在北京佑安医院对确诊的COVID-19病例进行了一项横断面研究。我们比较了有和没有肝脏疾病的患者入院时的临床特征、病毒血症状态和细胞因子谱。在分析的44例COVID-19患者中，两组之间的临床症状和体征、疾病严重程度或计算机断层扫描（CT）图像特征没有差异。淋巴细胞减少在肝脏疾病组中更为常见。此外，肝脏疾病组的C反应蛋白水平要高得多，IL-6、IL-10和M-CSF的浓度显著更高。仅7%的患者检测到病毒血症。由于病毒血症发生率较低，ACE2介导的病毒性肝炎似乎不能解释COVID-19患者中常见的肝脏疾病。相比之下，免疫反应失调可能是COVID-19早期肝脏疾病的关键致病因素。
