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病例报告:一名肝硬化合并新型冠状病毒肺炎患者的临床特征

Case Report: Clinical Features of a COVID-19 Patient With Cirrhosis.

作者信息

Zhou Jian, Jiang Dixuan, Wang Wanchun, Huang Kang, Zheng Fang, Xie Yuanlin, Zhou Zhiguo, Sun Jingjing

机构信息

Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China.

Department of Respiratory Medicine, The First Hospital of Changsha City, Changsha, China.

出版信息

Front Med (Lausanne). 2021 Nov 26;8:678227. doi: 10.3389/fmed.2021.678227. eCollection 2021.

Abstract

Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, Hubei Province, China in December 2019. At present, COVID-19 has emerged as a global pandemic. The clinical features of this disease are not fully understood, especially the interaction of COVID-19 and preexisting comorbidities and how these together further impair the immune system. In this case study, we report a COVID-19 patient with cirrhosis. A 73-year-old woman with cirrhosis reported a fever and cough on February 6, 2020. CT of the chest indicated an infection in her bilateral lungs. She tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The woman was treated with lopinavir and ritonavir tablets and interferon alpha-2b injection, but there was no obvious effect. Although this patient was basically asymptomatic after 2 days in the hospital, the inflammation of the bilateral lungs was slow to subside as shown in CT of the chest. In addition, the white blood cell count (WBC), absolute neutrophil count, and absolute lymphocyte count remained decreased and the result of real-time reverse transcription polymerase chain reaction (PCR) (rRT-PCR) assay was still positive for SARS-CoV-2 on hospital day 28. After infusion of plasma from a recovered COVID-19 patient four times, the patient tested negative for SARS-CoV-2. She was discharged on March 13, 2020. This patient tested negative for SARS-CoV-2 after infusion of plasma from a recovered COVID-19 patient four times. Cirrhosis could impair the homeostatic role of the liver in the systemic immune response, which may affect the removal of SARS-CoV-2. This could lead to a diminished therapeutic effect of COVID-19. Thus, clinicians should pay more attention to COVID-19 patients with cirrhosis.

摘要

2019年冠状病毒病(COVID-19)于2019年12月在中国湖北省武汉市首次报告。目前,COVID-19已成为全球大流行疾病。这种疾病的临床特征尚未完全明确,尤其是COVID-19与既往合并症之间的相互作用以及它们如何共同进一步损害免疫系统。在本病例研究中,我们报告了一名患有肝硬化的COVID-19患者。一名73岁的肝硬化女性于2020年2月6日出现发热和咳嗽症状。胸部CT显示其双侧肺部感染。她的严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染检测呈阳性。该女性接受了洛匹那韦和利托那韦片以及干扰素α-2b注射治疗,但效果不明显。尽管该患者住院2天后基本无症状,但胸部CT显示双侧肺部炎症消退缓慢。此外,白细胞计数(WBC)、绝对中性粒细胞计数和绝对淋巴细胞计数仍持续降低,且在住院第28天时实时逆转录聚合酶链反应(PCR)(rRT-PCR)检测结果仍显示SARS-CoV-2呈阳性。在输注了4次康复COVID-19患者的血浆后,该患者的SARS-CoV-2检测呈阴性。她于2020年3月13日出院。该患者在输注了4次康复COVID-19患者的血浆后,SARS-CoV-2检测呈阴性。肝硬化可能会损害肝脏在全身免疫反应中的稳态作用,这可能会影响SARS-CoV-2的清除。这可能导致COVID-19的治疗效果降低。因此,临床医生应更加关注患有肝硬化的COVID-19患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1962/8662523/544119fbb59d/fmed-08-678227-g0001.jpg

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