Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
Am J Trop Med Hyg. 2022 Oct 17;107(5):1107-1113. doi: 10.4269/ajtmh.22-0339. Print 2022 Nov 14.
Chikungunya is a mosquito-borne disease mainly characterized by fever with polyarthralgia. Currently, liver complications of chikungunya remain rarely described. This study assesses the prevalence, severity, and risk factors of liver involvement, and the association between liver involvement severity and prognosis. We conducted a retrospective cohort study at two referral centers for tropical infectious diseases-the Hospital for Tropical Diseases and Bamrasnaradura Infectious Diseases Institute in Thailand-from January 2016 to April 2021. The study included 400 patients diagnosed with chikungunya. Of them, 254 (63.5%) were female with a mean age of 41.5 ± 14.1 years, and 98.5% of them presented with fever with arthralgia. Gastrointestinal presentations included nausea or vomiting (n = 62, 15.5%), diarrhea (n = 33, 8.3%), and abdominal pain (n = 4, 1%). Of 88 patients with available liver function tests, 39.8% had hepatitis (abnormal alanine aminotransferase levels), of whom 5.7% had moderate hepatitis. Nausea or vomiting is a clinical risk factor associated with liver involvement (adjusted odds ratio, 5.17; 95% CI, 1.20-22.34). Liver involvement was usually observed during the first 2 weeks of illness and resolved eventually. None of the patients experienced severe hepatitis, liver failure, or death caused by a liver problem. In conclusion, most of the patients with chikungunya did not have significant liver involvement. In those patients with severe liver injury, coexisting causes should be considered.
基孔肯雅热是一种主要以发热伴多关节痛为特征的蚊媒疾病。目前，基孔肯雅热的肝脏并发症仍很少见。本研究评估了肝脏受累的患病率、严重程度和危险因素，以及肝脏受累严重程度与预后之间的关系。我们在泰国两家热带传染病转诊中心——热带病医院和 Bamrasnaradura 传染病研究所，进行了一项回顾性队列研究。研究纳入了 2016 年 1 月至 2021 年 4 月期间诊断为基孔肯雅热的 400 例患者。其中，254 例（63.5%）为女性，平均年龄为 41.5 ± 14.1 岁，98.5%的患者表现为发热伴关节痛。胃肠道表现包括恶心或呕吐（n = 62，15.5%）、腹泻（n = 33，8.3%）和腹痛（n = 4，1%）。在 88 例可进行肝功能检查的患者中，39.8%有肝炎（丙氨酸氨基转移酶水平异常），其中 5.7%有中度肝炎。恶心或呕吐是与肝脏受累相关的临床危险因素（调整优势比，5.17；95%可信区间，1.20-22.34）。肝脏受累通常在疾病的前 2 周内观察到，最终会痊愈。没有患者出现严重肝炎、肝功能衰竭或由肝脏问题引起的死亡。总之，大多数基孔肯雅热患者没有明显的肝脏受累。在那些有严重肝损伤的患者中，应考虑并存的原因。
