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[2019新型冠状病毒奥密克戎变异株相关肝功能损伤分析]

[Analysis of liver function injury associated with 2019-nCoV Omicron mutant strains].

作者信息

Yuan W, Lyu Y, Shi D L, Liao Y X, Li F, Shen Y Z, Ling Y

机构信息

Department of Liver Intensive Care Unit,Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China.

Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2022 May 20;30(5):513-519. doi: 10.3760/cma.j.cn501113-20220324-00136.

Abstract

To investigate the clinical features and influencing factors of liver function injury in patients with 2019-nCoV/SARS-CoV-2 Omicron mutant strains. 1 183 confirmed imported cases of SARS-CoV-2 who were admitted at Shanghai Public Health Clinical Center (affiliated to Fudan University) from July 1, 2021 to January 15, 2022 were collected. Clinical data, viral genotyping and laboratory test results were collected to retrospectively analyze the basic condition and clinical characteristics of liver function injury. Statistical analysis was performed using t-test or Wilcoxon rank-sum test, test or Fisher's exact test, Pearson correlation test and logistic regression analysis. 125 (10.6%) cases had raised baseline ALT level and 60 (5.1%) cases had abnormal baseline AST level. Among them, 33 cases (2.8%) had received hepatoprotective drugs. Liver function injury was generally mild in SARS-CoV-2 infection and minimal in Omicron mutant strains. Leukocyte count was increased in patients with raised alanine aminotransferase (ALT) [(6.96±1.78)×10/L (6.41±1.96)×10/L, =0.005 2], CT scan showed the proportion of liver hypodensity was significantly increased (2.4% . 0.3%, =0.018 0). High-sensitivity C-reactive protein [(7.83±22.36) mg/L (2.68±6.21) mg/L, =0.007 8] and D-dimer [(0.34±0.39) μg/ml (0.31±0.75) μg/ml, =0.047 5] levels were higher in patients with raised AST than normal group. 26 cases had normal liver function at hospital admission; however, abnormal liver function was occurred during the course of the disease. Another 8 patients had abnormal liver function at hospital admission, and reduced liver function further during the course of treatment. Recovery time and length of hospital stay was significantly affected in patients with worsened liver function. Baseline body mass index value [odds ratio ()]=1.80, =0.047), non-Omicron strains (=12.63, =0.046), D-dimer (=2.36, =0.047) and interleukin-6 levels (=1.03, =0.009), and those who used glucocorticoids and/or ulinastatin after hospital admission (=6.89, =0.034) had a higher risk of worsening liver function. Liver dysfunction could be observed among COVID-19 patients. Patients infected with omicron variant generally showed mild liver injury. Dynamic monitoring of liver function is necessary, especially among those with baseline elevated IL-6, D-Dimer level and use of antiinflammation medication during treatment.

摘要

为探讨2019-nCoV/SARS-CoV-2奥密克戎变异株感染患者肝功能损伤的临床特征及影响因素。收集2021年7月1日至2022年1月15日在上海公共卫生临床中心(复旦大学附属)收治的1183例确诊的SARS-CoV-2输入病例。收集临床资料、病毒基因分型及实验室检查结果,回顾性分析肝功能损伤的基本情况及临床特征。采用t检验或Wilcoxon秩和检验、检验或Fisher确切概率法、Pearson相关检验及Logistic回归分析进行统计学分析。125例(10.6%)患者基线ALT水平升高,60例(5.1%)患者基线AST水平异常。其中33例(2.8%)接受过保肝药物治疗。SARS-CoV-2感染患者肝功能损伤一般较轻,奥密克戎变异株感染患者肝功能损伤最小。谷丙转氨酶(ALT)升高患者白细胞计数升高[(6.96±1.78)×10⁹/L比(6.41±1.96)×10⁹/L,t =0.005 2],CT扫描显示肝脏低密度影比例显著增加(2.4%比0.3%,t =0.018 0)。AST升高患者高敏C反应蛋白[(7.83±22.36)mg/L比(2.68±6.21)mg/L,t =0.007 8]和D-二聚体[(0.34±0.39)μg/ml比(0.31±0.75)μg/ml,t =0.047 5]水平高于正常组。26例患者入院时肝功能正常;然而,在病程中出现肝功能异常。另外8例患者入院时肝功能异常,在治疗过程中肝功能进一步下降。肝功能恶化患者的恢复时间和住院时间受到显著影响。基线体重指数值[比值比(OR)]=1.80,P =0.047)、非奥密克戎毒株(OR =12.63,P =0.046)、D-二聚体(OR =2.36,P =0.047)和白细胞介素-6水平(OR =1.03,P =0.009),以及入院后使用糖皮质激素和/或乌司他丁的患者(OR =6.89,P =0.034)肝功能恶化风险更高。新型冠状病毒肺炎患者中可观察到肝功能障碍。感染奥密克戎变异株的患者一般表现为轻度肝损伤。有必要动态监测肝功能,尤其是基线白细胞介素-6、D-二聚体水平升高及治疗期间使用抗炎药物的患者。

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