新型冠状病毒Delta和Omicron变异株感染的儿童肝功能特征分析

赵夜; 关家龙; 麦玉珍; 邓浩辉

doi:10.3969/j.issn.1001-5256.2022.09.023

新型冠状病毒Delta和Omicron变异株感染的儿童肝功能特征分析

DOI: 10.3969/j.issn.1001-5256.2022.09.023

广州医科大学附属市八医院隔离二十区，广州 510060

基金项目:

广东省医学科学技术研究基金项目 (B2021302);

广州市医学重点学科经费(2021-2023年)-病毒性传染病 (202208XK0002)

伦理学声明：本研究方案于2020年1月31日经由广州医科大学附属市八医院伦理委员会审批，批号：202001134，所纳入患儿均由患者家属签署知情同意书。

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：赵夜负责课题设计，撰写论文；关家龙、麦玉珍参与临床数据的收集与统计分析；邓浩辉负责拟定写作思路，指导撰写论文，修改论文并最后定稿。

详细信息

通信作者:
邓浩辉，gz8hdhh@126.com

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出版历程
- 收稿日期: 2022-05-13
- 录用日期: 2022-06-15
- 出版日期: 2022-09-20

Features of liver function in pediatric patients infected with Delta variant versus Omicron variant of severe acute respiratory syndrome coronavirus 2

No. 20 Isolation Ward, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou 510060, China

Research funding:

Medical Scientific Research Foundation of Guangdong Province (B2021302);

Foundation of Key Medical Disciplines in Guangzhou Gity(2021-2023)-Viral Infectious Diseases (202208XK0002)

More Information

Corresponding author: DENG Haohui, gz8hdhh@126.com(ORCID: 0000-0001-5948-9101)

摘要

摘要: 目的总结和分析新型冠状病毒(SARS-CoV-2)Delta与Omicron变异株感染儿童的肝功能特征。方法对2021年5月21日起广州医科大学附属市八医院收治的本土或入境SARS-CoV-2感染的儿童住院隔离期间肝功能检查结果进行总结分析，并比较SARS-CoV-2 Delta和Omicron变异株感染的儿童各临床资料以及肝损伤的构成比。计量资料两组间比较采用独立样本t检验或Mann-Whitney U检验；计数资料两组间比较采用χ²检验或Fisher’s精确检验。结果共纳入85例SARS-CoV-2感染的儿童，其中包括32例(37.6%)Delta和53例(62.4%)Omicron变异株感染者，两组患儿年龄、性别、身高、体质量和合并疾病比较，差异均无统计学意义(P值均＞0.05)。SARS-CoV-2 Delta和Omicron变异株感染的儿童ALT、AST、ALP、GGT、TBil、Alb和ChE差异均无统计学意义(P值均＞0.05)；Omicron变异株感染的儿童其TBA水平显著高于Delta变异株感染的儿童(Z=-2.336，P=0.020)。但两组患儿TBA中位数均在正常范围内，且异常的TBA构成比在两组间比较，差异无统计学意义(P＞0.05)。85例儿童中10例(11.8%)出现肝功能指标轻度升高，其中7例TBA水平升高，1例ALT水平升高，1例ALT和AST水平升高，1例ALP水平升高。对SARS-CoV-2 Delta和Omicron变异株感染的儿童肝损伤分析结果显示，两种SARS-CoV-2变异株感染所致肝损伤的构成比差异无统计学意义(6.3% vs 15.1%，χ²=0.691，P=0.406)。结论 SARS-CoV-2 Delta和Omicron变异株感染的儿童近期肝损伤较轻，但其感染所致远期肝功能损伤的影响有待进一步评估。
- 新型冠状病毒 /
- 肝损伤 /
- 儿童
Abstract: Objective To summarize and analyze the features of liver function in pediatric patients infected with Delta variant versus Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods In this study, an analysis was performed for the liver function test results of the locally transmitted or imported pediatric patients with SARS-CoV-2 infection during isolation who were admitted to Guangzhou Eighth People's Hospital, Guangzhou Medical University, since May 21, 2021, and the clinical data and the constituent ratio of liver injury were compared between the pediatric patients infected with Delta variant and those infected with Omicron variant. The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. Results A total of 85 pediatric patients infected with SARS-CoV-2 were enrolled, among whom there were 32 (37.6%) pediatric patients infected with Delta variant and 53 (62.4%) pediatric patients infected with Omicron variant, and there were no significant differences between the two groups in age, sex, body height, body weight, and comorbidities (all P > 0.05). There were no significant differences between the two groups in alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase, total bilirubin, albumin, and cholinesterase (all P > 0.05), and the pediatric patients infected with Omicron variant had a significantly higher level of total bile acid (TBA) than those infected with Delta variant (Z=-2.336, P=0.020). However, the median values of TBA were within the normal range and the ratios of abnormal TBA were no significant difference between the two groups (P > 0.05). Among the 85 pediatric patients, 10 (11.8%) had a mild increase in liver function parameters, among whom 7 had an increase in TBA, 1 had an increase in ALT, 1 had increases in ALT and AST, and 1 had an increase in ALP. The analysis of liver injury in the pediatric patients infected with Delta variant or Omicron variant showed that there was no significant difference in the constituent ratio of liver injury caused by the two variants (6.3% vs 15.1%, χ²=0.691, P=0.406). Conclusion Mild liver injury is observed in pediatric patients infected with Delta and Omicron variants of SARS-CoV-2, but further studies are needed to evaluate the long-term influence of such infection on liver function.
- SARS-CoV-2 /
- Liver Injury /
- Child

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表 1 SARS-CoV-2 Delta和Omicron变异株感染的85例儿童一般资料分析

Table 1. Basic clinical data of 85 SARS-CoV-2 Delta and Omicron variant infected pediatric patients

项目	Delta变异株感染(n=32)	Omicron变异株感染(n=53)	统计值	P值
年龄(岁)	8.0(3.3~11.0)	6.0(3.0~9.0)	Z=-1.455	0.146
性别[例(%)]			χ²=3.125	0.077
男	13(40.6)	32(60.4)
女	19(59.4)	21(39.6)
身高(cm)
0~5岁	92.3±13.3	94.3±14.6	t=-0.398	0.693
6~10岁	135.8±10.4	131.5±11.8	t=0.865	0.396
10岁以上	155.0±7.0	142.9±47.2	t=-1.528	0.129
体质量(kg)
0~5岁	14.6±3.8	14.8±5.2	t=-0.159	0.874
6~10岁	27.6±4.9	27.3±8.9	t=0.089	0.930
10岁以上	42.1±4.9	47.6±10.7	t=0.880	0.389
临床分型[例(%)]			χ²=15.401	＜0.001
无症状感染者	12(37.5)	8(15.1)
轻型	13(40.6)	43(81.1)
普通型	7(21.9)	2(3.8)
疫苗接种[例(%)]			χ²=23.255	＜0.001
是	1(3.1)	29(54.7)
否	31(96.9)	24(45.3)
合并疾病[例(%)]				0.241
G6PD缺乏症	0	4(7.5)
哮喘	1(3.1)	1(1.9)
乳糖不耐受	0	1(1.9)
巨趾症	1(3.1)	0
注：G6PD缺乏症，葡萄糖-6-磷酸脱氢酶缺乏症。

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表 2 SARS-CoV-2 Delta和Omicron变异株感染的儿童肝功能指标比较

Table 2. Comparison of liver function tests between SARS-CoV-2 Delta and Omicron variant infected pediatric patients

肝功能指标	Delta变异株感染(n=32)	Omicron变异株感染(n=53)	Z值	P值
ALT(U/L)	11.1(9.2~15.3)	12.7(10.0~16.0)	-1.339	0.181
AST(U/L)	24.1(17.8~29.6)	26.8(23.0~38.2)	-1.824	0.068
TBA(μmol/L)	3.1(2.4~5.2)	5.0(3.0~7.6)	-2.336	0.020
ALP(U/L)	232.5(206.5~285.0)	251.0(218.0~298.0)	-1.034	0.301
GGT(U/L)	11.5(9.3~13.0)	10.0(7.0~12.0)	-1.318	0.188
TBil(μmol/L)	5.1(3.7~6.3)	4.5(3.3~5.9)	-0.272	0.768
Alb(g/L)	46.2(44.4~47.4)	45.3(43.7~47.0)	-1.025	0.305
ChE(kU/L)	8.8(7.2~9.2)	8.8(8.1~10.1)	-1.096	0.273

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表 3 10例SARS-CoV-2感染致肝损伤的儿童各项肝功能指标的峰值

Table 3. Abnormal liver function tests in SARS-CoV-2 Delta and Omicron variant infected pediatric patients

患者	年龄	性别	毒株	ALT(U/L)	AST(U/L)	ALP(U/L)	TBA(μmol/L)
病例1	6岁	男	Omicron	60.0	正常	正常	正常
病例2	7岁	男	Omicron	77.0	82.0	正常	正常
病例3	2岁5月龄	女	Delta	正常	正常	840.0	正常
病例4	5岁	女	Omicron	正常	正常	正常	13.3
病例5	1岁	男	Omicron	正常	正常	正常	15.7
病例6	7岁	女	Omicron	正常	正常	正常	16.6
病例7	1岁3月龄	女	Delta	正常	正常	正常	16.7
病例8	5岁	女	Omicron	正常	正常	正常	16.9
病例9	2岁	女	Omicron	正常	正常	正常	23.1
病例10	5岁	男	Omicron	正常	正常	正常	33.8
注：ALT正常值参考范围(1~12岁)12~45 U/L；AST正常值参考范围(3~9岁)15~50 U/L；ALP正常值参考范围(1~9岁)100~420 U/L；TBA正常值参考范围0~10 μmol/L。

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