重型和危重型新型冠状病毒肺炎患者肝功能损害回顾性分析

doi:10.3969/j.issn.1672-5069.2020.05.013

摘要/Abstract

摘要： 目的探讨不同性别和年龄组肝重型和危重型冠状病毒疾病-19(COVID-19)病毒感染患者肝功能相关指标、治疗药物和疾病转归情况,为临床诊治该类肝损害提供经验。方法 2020年1月22日～2月22日我院收治的重型和危重型COVID-19感染患者27例,回顾性分析其临床特征、不同性别和年龄组入院首次肝功能相关指标、治疗药物和疾病转归情况。结果在27例重型和危重型COVID-19感染患者中,男性22例(81.5%),女性5例(18.5%);年龄为29～91岁,中位年龄为56.0(44.0～68.0)岁。其中<60岁中青年组16例(59.3%),>60岁老年组11例(40.7%);26例(96.3%)患者出现血清ALT、AST、GGT、ALP、TBIL、PTA、DBIL和LDH水平异常;男性组与女性组血清ALT、AST、GGT、ALP、TBIL、PTA、DBIL和LDH水平比较,差异无统计学意义(P＞0.05);中青年组与老年组血清ALT、AST、GGT、ALP、TBIL、DBIL和LDH水平比较,差异无统计学意义(P＞0.05),但老年组PTA水平显著低于中青年组,差异有统计学意义(P＜0.05);22例(81.5%)接受了联合抗病毒药物,18例(66.7%)接受了联合抗炎、调节免疫类中成药物,14例(51.9%)接受了联合护肝药物;自发病起1个月时间内,本组生存率为96.3%。结论重型和危重型COVID-19感染患者病程早期容易出现肝损害,不同性别和年龄患者肝损伤差异不大。在中西药应用过程中出现肝损害,其与药物应用有关还是病毒感染本身的作用,还有待进一步探讨。

关键词: 肝损害, 新型冠状病毒肺炎, 重型和危重型, 回顾性分析 , ,

Abstract: Objective To summarize the feature of liver injuries, therapeutic medicines and disease outcomes of patients with coronavirus disease-19 (COVID-19) infection. Methods 27 patients with severe and critical COVID-19 infection were admitted to our hospital between January 22 and February 22,2020, and their clinical characteristics, liver function tests in different genders and ages,therapeutic medicines and disease outcomes were summarized retrospectively. Results Among the 27 patients with severe and critical COVID-19 infection,22(81.5%) were males and 5(18.5%) were females,aged 29 to 91 years old,with a median age of 56.0(44.0-68.0) years old; among them,16 cases (59.3%) were in the young and middle-aged group (<60 years old),and 11 cases (40.7%) were in the elderly group (>60 years old); serum levels of ALT,AST,GGT,ALP,bilirubin,PTA,direct bilirubin and LDH were abnormal in 26 cases (96.3%) at early stage,and serum levels of total bilirubin and direct bilirubin elevated in 1 patient (3.7%) during hospitalization; there were no statistically significant differences between serum levels of ALT,AST,GGT,ALP,TBIL,PTA,DBIL and LDH between the male and the female group (P>0.05); serum levels of ALT,AST,GGT,ALP,TBIL,DBIL and LDH in the young and middle-aged groups were not statistically significant compared to those in the elderly group (P>0.05); however, the PTA level decreased in the elderly group (P<0.05); 22 cases (81.5%) received combined antiviral agents, 18 patients (66.7%) received combined anti-inflammatory and immune-regulating medicines,and 14 patients (51.9%) received combined hepatoprotective drugs; within 1 month after onset of the pandemic, the survival rate in our series was 96.3%. Conclusion Patients with severe and critical COVID-19 infection are prone to liver damages at early stage of the disease, which might be related to the medications or the virus infection itself should be elucidated further.

Key words: Liver injury, COVID-19 infection, Severe and critical clinical types, Retrospective analysis

江守伟, 金坤, 沈强, 韩华, 刘磊, 杨云, 杨田军, 潘爱军, 李磊. 重型和危重型新型冠状病毒肺炎患者肝功能损害回顾性分析[J]. 实用肝脏病杂志, 2020, 23(5): 654-657.

Jiang Shouwei, Jin Kun, Shen Qiang,et al.. Retrospective analysis of liver injuries in patients with coronavirus disease 19 infection[J]. Journal of Practical Hepatology, 2020, 23(5): 654-657.

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