Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Center of Integrative Medicine, Peking University Ditan Teaching Hospital, Beijing, China.
Front Cell Infect Microbiol. 2023 May 3;13:1178590. doi: 10.3389/fcimb.2023.1178590. eCollection 2023.
Ursodeoxycholic acid (UDCA) may reduce susceptibility to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection by downregulating angiotensin-converting enzyme 2 (ACE2), based on recent experimental investigation. This study aimed to determine the potential protective effect of UDCA against SARS-CoV-2 infection in patients with chronic liver disease.
Patients with chronic liver disease receiving UDCA (taking UDCA ≥1 month) at Beijing Ditan Hospital between January 2022 and December 2022 were consecutively enrolled. These patients were matched in a 1:1 ratio to those with liver disease not receiving UDCA during the same period by using a propensity score matching analysis with nearest neighbor matching algorithm. We conducted a phone survey of coronavirus disease 2019 (COVID-19) infection during the early phase of the pandemic liberation (from 15 December 2022 to 15 January 2023). The risk of COVID-19 was compared in two matched cohorts of 225 UDCA users and 225 non-UDCA users based on patient self-report.
In the adjusted analysis, the control group was superior to the UDCA group in COVID-19 vaccination rates and liver function indicators, including γ-glutamyl transpeptidase and alkaline phosphatase (p < 0.05). UDCA was associated with a lower incidence of SARS-CoV-2 infection (UDCA 85.3% control 94.2%, p = 0.002), more mild cases (80.0% 72.0%, p = 0.047), and shorter median time from infection to recovery (5 7 days, p < 0.001). Logistic regression analysis showed that UDCA was a significant protective factor against COVID-19 infection (OR: 0.32, 95%CI: 0.16-0.64, p = 0.001). Furthermore, diabetes mellitus (OR: 2.48, 95%CI: 1.11-5.54, p = 0.027) and moderate/severe infection (OR: 8.94, 95%CI: 1.07-74.61, p = 0.043) were more likely to prolong the time from infection to recovery.
UDCA therapy may be beneficial in reducing COVID-19 infection risk, alleviating symptoms, and shortening the recovery time in patients with chronic liver disease. However, it should be emphasized that the conclusions were based on patient self-report rather than classical COVID-19 detection by experimental investigations. Further large clinical and experimental studies are needed to validate these findings.
基于最近的实验研究，熊去氧胆酸（UDCA）通过下调血管紧张素转换酶 2（ACE2）可能降低严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的易感性。本研究旨在确定 UDCA 对慢性肝病患者 SARS-CoV-2 感染的潜在保护作用。
2022 年 1 月至 2022 年 12 月，连续纳入在北京地坛医院接受 UDCA（UDCA 治疗≥1 个月）治疗的慢性肝病患者。通过最近邻匹配算法的倾向评分匹配分析，将这些患者与同期未接受 UDCA 治疗的肝病患者以 1:1 的比例匹配。我们在大流行早期（从 2022 年 12 月 15 日至 2023 年 1 月 15 日）对 2019 年冠状病毒病（COVID-19）感染进行了电话调查。根据患者自述，比较了 225 名 UDCA 使用者和 225 名非 UDCA 使用者两组的 COVID-19 风险。
在调整分析中，对照组在 COVID-19 疫苗接种率和肝功能指标（γ-谷氨酰转肽酶和碱性磷酸酶）方面优于 UDCA 组（均 p < 0.05）。UDCA 与 SARS-CoV-2 感染发生率较低相关（UDCA 为 85.3%，对照组为 94.2%，p = 0.002），更轻微的病例（80.0%，对照组为 72.0%，p = 0.047），以及从感染到恢复的中位时间更短（5 天，对照组为 7 天，p < 0.001）。Logistic 回归分析表明，UDCA 是 COVID-19 感染的显著保护因素（OR：0.32，95%CI：0.16-0.64，p = 0.001）。此外，糖尿病（OR：2.48，95%CI：1.11-5.54，p = 0.027）和中重度感染（OR：8.94，95%CI：1.07-74.61，p = 0.043）更有可能延长从感染到恢复的时间。
UDCA 治疗可能有助于降低慢性肝病患者 COVID-19 感染风险、减轻症状并缩短恢复时间。然而，应强调的是，这些结论是基于患者的自我报告，而不是通过实验研究进行的经典 COVID-19 检测。需要进一步的大型临床和实验研究来验证这些发现。
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