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201例新型冠状病毒肺炎患者肝损害临床特征分析
Clinical features of liver injury in patients with coronavirus disease 2019: An analysis of 201 cases
文章发布日期:2020年06月08日  来源:  作者:龙丹,秦凌辉,高山  点击次数:299次  下载次数:38次

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【摘要】:目的 了解新型冠状病毒肺炎(COVID-19)患者肝损害特征,为临床诊治工作提供参考。方法 收集2020年1月19日-3月5日湖北省襄阳市中心医院三院区收治的201例COVID-19患者的病历资料,分为非危重组(轻型/普通型,n=173)、危重组(重型/危重型,n=28)2组,收集ALT、AST、TBil、DBil及Alb等指标。计量资料组间比较采用t检验;计数资料组间比较采用χ2检验;等级资料组间比较采用Wilcoxon秩和检验。结果 201例患者中37例(18.4%)出现肝损害,危重组19例,非危重组18例,2组间肝损害发生率比较差异有统计学意义(67.9% vs 10.4%, χ2=52.963,P<0.05)。危重组肝损害患者与非危重组肝损害患者ALT和(或)AST水平异常时间(入院时和住院期间)情况比较差异有统计学意义(χ2=11.906,P<0.05);2组肝损害患者ALT和(或)AST水平升高情况比较差异有统计学意义(Z=-2.869,P<0.05),大部分患者为轻中度肝损害。201例患者中胆红素升高者1例(TBil<2倍正常值上限,且以IBil为主),为非危重肝损害患者。危重组肝损害患者Alb水平明显低于非危重组(t=-8.002,P<0.05); 201例患者中Alb水平下降者有75例,其中入院时50例(24.9%),住院期间25例(12.4%),2时间段患者Alb水平(t=-4.967,P<0.05)和低白蛋白血症情况(χ2=26.645,P<0.05)比较差异均有统计学意义。结论 COVID-19患者肝损害比较常见,以轻中度肝损害为主,胆红素异常发生率较低,Alb浓度下降发生率高,危重患者与非危重患者在肝损害发病率及严重程度具有显著差异,白蛋白水平能可作为评估及预测COVID-19患者病情严重程度指标之一。
【Abstract】:Objective To investigate the features of liver injury in patients with coronavirus disease 2019 (COVID-19), and to provide a reference for clinical diagnosis and treatment. Methods Medical records were collected from 201 patients with COVID-19 who were admitted to Xiangyang Central Hospital from January 19 to March 5, 2020, and these patients were divided into non-critical (mild/common type) group with 173 patients and critical (severe/critical type) group with 28 patients. The data on alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), direct bilirubin (DBil), and albumin (Alb) were collected. The t-test was used for comparison of normally distributed continuous data between groups, the chi-square test was used for comparison of categorical data between groups, and the Wilcoxon rank-sum test was used for comparison of ranked data between groups. Results Among the 201 patients, 37 (18.4%) had liver injury, with 19 in the critical group and 18 in the non-critical group, and there was a significant difference in the incidence rate of liver injury between the two groups (67.9% vs 10.4%, χ2=52.963, P<0.05). There were significant differences between the 19 patients with liver injury in the critical group and the 18 patients with liver injury in the non-critical group in the duration of abnormal ALT and/or AST (on admission and during hospitalization) (χ2=11.906, P<0.05) and the increase in ALT and/or AST (Z=-2.869, P<0.05), and most patients had mild or moderate liver injury. Among the 201 patients, only one patient had elevated bilirubin (TBil <2 × upper limit of normal, mainly indirect bilirubin) and had non-critical liver injury. The critical group had a significantly lower level of Alb than the non-critical group (t=-8.002, P<0.05). Among the 201 patients, 75 had a reduction in Alb, among whom 50 (50/201, 24.9%) had a reduction on admission and 25 (25/201, 12.4%) had a reduction during hospitalization, and there were significant differences in Alb (t=-4.967, P<0.05) and hypoalbuminemia (χ2=26.645, P<0.05) between the two periods of time. Conclusion Liver injury is relatively common in patients with COVID-19, mainly mild or moderate liver injury. There is a low incidence rate of abnormal bilirubin and a high incidence rate of the reduction in Alb. There are significant differences in the incidence rate and severity of liver injury between the crucial and non-critical patients. Alb level can be used as one of the indicators to evaluate and predict the severity of COVID-19 patients.
【关键字】:新型冠状病毒肺炎; 肝损害; 血清白蛋白
【Key words】:coronavirus disease 2019; liver injury; serum albumin
【引证本文】:LONG D, QIN LH, GAO S. Clinical features of liver injury in patients with coronavirus disease 2019: An analysis of 201 cases[J]. J Clin Hepatol, 2020, 36(7): 1567-1570. (in Chinese)
龙丹, 秦凌辉, 高山. 201例新型冠状病毒肺炎患者肝损害临床特征分析[J]. 临床肝胆病杂志, 2020, 36(7): 1567-1570.

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