Isa Hasan M, Hasan Asma Z, Khalifa Sara I, Alhewaizem Sana S, Mahroofi Abdulrahman D, Alkhan Fatema N, Al-Beltagi Mohammed
Department of Pediatrics, Salmaniya Medical Complex, Manama 12, Bahrain.
Department of Pediatrics, Arabian Gulf University, Manama 26671, Bahrain.
World J Hepatol. 2022 Oct 27;14(10):1907-1919. doi: 10.4254/wjh.v14.i10.1907.
Respiratory syncytial virus (RSV) is a prevalent cause of lower respiratory tract infections. It may be associated with hepatocellular involvement, as indicated by increased liver enzymes aspartate aminotransferase and alanine transaminase (ALT).
To evaluate the rate of increased liver enzyme levels in children with acute bronchiolitis and correlate them with clinical, laboratory, and radiological variables.
The study was a retrospective review of the medical records of children who presented with acute bronchiolitis when admitted to the Pediatric Department, Salmaniya Medical Complex, the Kingdom of Bahrain, between 2019 and 2020. We collected the demographic data, the clinical presentation, the laboratory and radiological findings, and the clinical outcomes. We compared the patients with elevated liver enzymes to those with normal levels at the time of presentation and at follow-up.
We included 166 (57.8%) of 287 patients with acute bronchiolitis who fulfilled the inclusion criteria. Ninety-three (56%) patients were males. The median age at presentation was 3.4 (interquartile range 1.1 to 12.4) mo. Fifty-four (28%) patients tested positive for RSV, which was confirmed in 15 of them (28%) by PCR. Laboratory findings of 161 patients tested at presentation showed high ALT levels in 14 (8.7%) patients and normal ALT in 147 (91.3%). Coagulation profiles were measured in 46 (27.7%) of 166 patients. High prothrombin time was present in 15 (32.6%), a high international normalized ratio was present in 13 (28.3%), and high activated partial thromboplastin time was present in three (6.5%). Thrombin time was elevated in nine (27.3%) of 33 patients. Five (21.7%) of 23 patients with available radiological data had hepatomegaly; one of them had findings suggestive of fatty infiltration. High ALT had a significant association with lengthy hospital stays ( < 0.05) and positive urine culture ( < 0.05). Seventy (42.2%) patients had documented follow-up with liver function tests over a median follow-up period of 10.2 (IQR, 2.4-23.3) mo. Total serum protein and serum globulin levels were normalized at the follow-up time, with a significant value of < 0.05.
This study showed a low prevalence of liver function involvement in patients with acute bronchiolitis with a benign course. However, there was a rising trend in ALT during follow-up. Prolonged hospital stay and positive urine cultures were associated with elevated liver enzymes.
呼吸道合胞病毒（RSV）是下呼吸道感染的常见病因。如天冬氨酸转氨酶和丙氨酸转氨酶（ALT）等肝酶升高所示，它可能与肝细胞受累有关。
评估急性细支气管炎患儿肝酶水平升高的发生率，并将其与临床、实验室及影像学变量相关联。
该研究是对2019年至2020年期间入住巴林王国萨尔曼尼亚医疗中心儿科、患有急性细支气管炎患儿的病历进行的回顾性分析。我们收集了人口统计学数据、临床表现、实验室及影像学检查结果以及临床结局。我们比较了就诊时及随访时肝酶升高的患者与肝酶水平正常的患者。
我们纳入了287例符合纳入标准的急性细支气管炎患者中的166例（57.8%）。93例（56%）患者为男性。就诊时的中位年龄为3.4（四分位间距1.1至12.4）个月。54例（(28%)）患者RSV检测呈阳性，其中15例（(28%)）经聚合酶链反应（PCR）确诊。161例患者就诊时的实验室检查结果显示，14例（(8.7%)）患者ALT水平升高，147例（(91.3%)）患者ALT正常。166例患者中的46例（(27.7%)）检测了凝血指标。凝血酶原时间延长的有15例（(32.6%)），国际标准化比值升高的有13例（(28.3%)），活化部分凝血活酶时间延长的有3例（(6.5%)）。33例患者中有9例（(27.3%)）凝血酶时间延长。23例有可用影像学数据的患者中有5例（(21.7%)）有肝肿大；其中1例有提示脂肪浸润的表现。ALT升高与住院时间延长（(P<0.05)）及尿培养阳性（(P<0.05)）显著相关。70例（(42.2%)）患者在中位随访期10.2（四分位间距，2.4 - 23.3）个月时进行了肝功能检查的记录随访。随访时总血清蛋白和血清球蛋白水平恢复正常，(P)值显著小于0.05。
本研究显示急性细支气管炎患者肝功能受累的发生率较低，病程呈良性。然而，随访期间ALT有上升趋势。住院时间延长和尿培养阳性与肝酶升高有关。
