Sun Tong, Chi Hongbo, Wang Jing, Zheng Yufen, Zhu Hongguo, Zhao Jingxian, Zhou Kai, Chen Mengyuan, Wang Donglian, Tung Tao-Hsin, Xu Jiaqin, Shen Bo
Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou, Medical University, 150 Ximen Road, Linhai, Taizhou, 317000, Zhejiang Province, China.
Key Laboratory of System Medicine and Precision Diagnosis and Treatment of Taizhou, 150 Ximen Road, Linhai, Taizhou, Zhejiang Province, China.
BMC Infect Dis. 2024 Dec 18;24(1):1428. doi: 10.1186/s12879-024-10324-0.
To investigate the impact of SARS-CoV-2 infection on liver function and prognosis in patients with HBV infection.
A total of 154 HBV-positive patients (HBV ( +) group) and 154 HBV-negative patients (HBV (-) group) diagnosed with COVID-19 at Taizhou Hospital between December 10, 2022, and January 31, 2023, were included in this study. Clinical characteristics, treatment, and laboratory findings were collected from patients at three time points: before (T1), during (T2), and at the time of discharge (T3) from SARS-CoV-2 infection.
Compared to the HBV (-) group, the HBV ( +) group had a longer hospital stay (15 (9-22) days vs. 9 (5-16) days). Longitudinal comparisons of laboratory indicators from T1 to T3 showed a continuous decline in TP and ALB levels and a continuous increase in PT and TT levels in the HBV ( +) group. BUN levels increased during T2 and decreased thereafter. These differences were considered statistically significant (P < 0.05). Notably, the HBV ( +) group had a higher proportion of indicators elevated > 3 ULN from T1 to T2, including ALT (1.95%/5.19%), AST (3.25%/12.99%), ALP (1.95%/3.25%), GGT (4.55%/9.09%), TBIL (6.49%/9.09%), and DBIL (18.18%/22.73%). In the HBV (-) group, the elevations were mainly concentrated within 1-2 ULN, including AST (12.99%/22.08%), DBIL (10.39%/21.43%), BUN (12.99%/22.08%), CREA (20.13%/29.22%), and PLT (7.79%/14.94%). Furthermore, the incidence of liver injury from T1 to T3 was higher in the HBV ( +) group compared to the HBV (-) group (15.7% (20/127) vs. 7.2% (11/152), P < 0.05). Multivariate analysis showed that liver cirrhosis (HR = 4.847, 95% CI: 1.224-19.20, P = 0.025) and liver cancer (HR = 8.333, 95% CI: 2.156-32.209, P = 0.002) were independent risk factors for liver injury in the presence of SARS-CoV-2 infection.
SARS-CoV-2 infection has a higher proportion of liver injury in HBV-infected patients, affecting hepatic protein synthesis function. Those with cirrhosis and hepatocellular carcinoma are at higher risk of severe liver injury.
探讨新型冠状病毒2（SARS-CoV-2）感染对乙型肝炎病毒（HBV）感染患者肝功能及预后的影响。
本研究纳入了2022年12月10日至2023年1月31日期间在台州医院确诊为新型冠状病毒肺炎的154例HBV阳性患者（HBV（+）组）和154例HBV阴性患者（HBV（-）组）。收集患者在三个时间点的临床特征、治疗情况和实验室检查结果：新型冠状病毒2感染前（T1）、感染期间（T2）和出院时（T3）。
与HBV（-）组相比，HBV（+）组住院时间更长（15（9 - 22）天 vs. 9（5 - 16）天）。对HBV（+）组从T1到T3的实验室指标进行纵向比较，发现总蛋白（TP）和白蛋白（ALB）水平持续下降，凝血酶原时间（PT）和凝血酶时间（TT）水平持续升高。尿素氮（BUN）水平在T2时升高，之后下降。这些差异具有统计学意义（P < 0.05）。值得注意的是，HBV（+）组从T1到T2指标升高超过3倍正常上限（ULN）的比例更高，包括谷丙转氨酶（ALT）（1.95%/5.19%）、谷草转氨酶（AST）（3.25%/12.99%）、碱性磷酸酶（ALP）（1.95%/3.25%）、γ-谷氨酰转肽酶（GGT）（4.55%/9.09%）、总胆红素（TBIL）（6.49%/9.09%）和直接胆红素（DBIL）（18.18%/22.73%）。在HBV（-）组中，升高主要集中在1 - 2倍ULN范围内，包括AST（12.99%/22.08%）、DBIL（10.39%/21.43%）、BUN（12.99%/22.08%）、肌酐（CREA）（20.13%/29.22%）和血小板（PLT）（7.79%/14.94%）。此外，与HBV（-）组相比，HBV（+）组从T1到T3肝损伤的发生率更高（15.7%（20/127） vs. 7.2%（11/152），P < 0.05）。多因素分析显示，肝硬化（HR = 4.847，95%可信区间：1.224 - 19.20，P = 0.025）和肝癌（HR = 8.333，95%可信区间：2.156 - 32.209，P = 0.002）是新型冠状病毒2感染时肝损伤的独立危险因素。
新型冠状病毒2感染在HBV感染患者中导致肝损伤的比例更高，影响肝脏蛋白质合成功能。肝硬化和肝细胞癌患者发生严重肝损伤的风险更高。
