严重急性呼吸综合征患者肝功能损害的动态观察

目的 动态观察严重急性呼吸综合征(SARS)患者的肝功能损害情况。方法 125例SAPS患者均在发病第1周、2周、4周、8周、12周空腹采血进行血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)和其他相关指标的动态监测,分析总结SARS病程中各肝功能指标的变化规律。结果 在SARS病程的第1、2周ALT开始升高,第4周后随病情好转开始缓慢下降,持续到第8周左右,到病程第12周才能完全恢复正常,重型患者比普通型患者恢复得慢。在SARS病程中AST升高不多,且在病程第4-8周时能很快恢复正常,重型患者升高的幅度较普通型患者高。部分病例的其他肝功能指标在ALT、AST峰值时有一过性改变,但很快恢复正常。结论 SAPS患者存在明显的肝功能损害,且恢复较慢,提示在临床诊治过程中要注意护肝治疗。     

259例传染性非典型肺炎患者肝功能和心肌酶的动态变化

目的 观察传染性非典型肺炎(严重急性呼吸综合症,SARS)患者肝功能和心肌酶的动态变化及可能的影响因素。方法 回顾性分析259例SARS患者肝功能及心肌酶的动态变化。结果 ALT升高者占56.3％,AST升高者占37.1％,LDH和HBDH升高分别为64.5％和61.4％。LDH、HBDH升高大都在病程的第1～2周,而肝功能异常大多出现在病程的第2～3周。普通型和重型SARS患者在肝功能异常比例及升高幅度上无明显差异,重型组LDH、HBDH的升高比例明显高于普通型组,且恢复缓慢。同时使用糖皮质激素、利巴韦林和大环内酯类抗生素可能加重肝脏损伤。结论SARS患者出现肝功能异常是多种因素造成的,可能与病毒所介导的细胞因子、炎性介质所导致的免疫损伤、多器官功能障碍及药物损伤有关。心肌酶升高与病毒血症期、肺脏病变平行,可能与SARS病毒所致的肺脏和心肌损伤有关。     

急性胰腺炎肝功能损害37例

目的探讨急性胰腺炎(AP)的肝功能损害及不同诱因的肝功能损害程度及发生率。方法分析82例AP患者丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、总胆红素(TB iL)、直接胆红素(DB iL)及白蛋白(ALB)的检查结果。结果37例有肝功能损害(45.12%)。轻型AP 69例,发生肝功能损害24例(66.70%);重型AP 13例,发生肝功能损害13例(100%)。胆源性AP 33例,发生肝功能损害20例(60.61%),明显高于非胆源性AP的34.69%。结论AP的肝功能损害较常见,重型AP的肝功能损害发生率100%,损害程度明显高于轻型AP;胆源性AP的肝功能损害程度及肝功能损害发生率明显高于非胆源性AP。     

严重急性呼吸道综合征并发肝脏损害的临床特点与机制探讨

目的 探讨严重急性呼吸道综合征(SARS)并发肝脏损害的临床特点,分析其可能的原因,以进一步阐明SARS的发病机制,为临床治疗提供依据。方法 对154例SARS患者,观察了临床症状、体征、肝功能等。其中46例患者系统检测了血清白细胞介素(IL)-1 β、IL-2、IL—4、IL—6、IL—8、IL—10、肿瘤坏死因子(TNF)α、内毒素和甲～戊型肝炎病毒标志物。部分病例进行了肝脏B型超声和病理学检查。另有15例健康者及22例同期住院的慢性肝病患者作为对照。结果 37.7％的SARS患者入院时丙氨酸氨基转移酶(ALT)或/和天门冬氨酸氨基转移酶(AST)升高,其中43.1%轻度升高(<80 U/L),56.9%中度升高。肝功能异常以ATL单项增高为主(70.7％),其次为ALT与AST同时异常(22.4％),少数单纯AST增高。75.9％患者转氨酶在2周内恢复正常,有4例入院时转氨酶正常而在住院过程中升高。重型SARS患者转氨酶异常率显著高于轻型,x~2=19.28,P<0.05。住院期间24.0％患者血清白蛋白下降,28.6％前白蛋白降低,8.4％总胆红素升高,72.7％患者入院时肌酸激酶或(和)心肌型肌酸激酶同功酶异常。IL-1等6种白细胞介素与TNF—α在急性期均显著高于恢复期、正常对照组和慢性肝病组,t=1.67～6.48,P<0.05～0.01。ALT异常组IL-1 β、IL-6和IL-10显著高于ALT正常组,t-2.36～     

新型冠状病毒肺炎患者血氧饱和度与肝功能异常的相关性

目的分析COVID-19新型冠状病毒肺炎患者血氧饱和度与肝功能异常及临床治疗的相关性。方法观察74例确诊的COVID-19新冠肺炎住院患者比较轻型/普通型(46例)和重型/危重型(28例)患者肝功能异常的发生率,以及治疗前后血氧饱和度和肝功能生化指标的变化,分析患者血氧饱和度与肝功能等生化指标变化的相关性。结果轻型/普通型和重型/危重型患者在氧饱和度(96.52±1.68 VS 87.61±2.99)、ALT(39.69±25.35 VS 57.25±37.89)、AST(29.28±15.38 VS 43.57±19.31)、LDH(218.56±72.85 VS 262.07±80.05)等指标中存在明显差异(P0.05);在肝功能异常患者中,治疗后血氧饱和度恢复正常,两组患者肝功能均有不同程度恢复,轻型/普通型患者ALT(66.82±21.65VS 42.47±18.46)、AST(61.00±17.66 VS 36.83±16.30)及LDH(309.46±58.92 VS 218.38±45.12),和重型/危重型ALT(93.54±21.06 VS 49.54±19.75)、AST(57.93±14.22 VS 33.80±11.28)及LDH(329.79±54.78 VS 257.50±90.59)均明显好转,存在统计学差异(P0.05);肝功能指标与氧饱和度的相关性分析中,ALT、AST、r-GT及LDH和氧饱和度存在负相关性(P0.05)。结论新冠肺炎患者低血氧饱和度和肝功能异常密切相关,血氧饱和度的恢复有利于改善肝功能。     

112例新型冠状病毒肺炎患者肝肾功能和心肌酶学变化分析

目的 观察新型冠状病毒肺炎(COVID-19)患者血清肝肾功能和心肌酶学的变化。方法 在本组112例COVID-19肺炎患者中,普通型68例,重型22例,危重型22例。常规检测血清肝肾功能指标及肌钙蛋白T(cTnT)、肌红蛋白(Myo)和肌酸激酶同工酶(CK-MB)。结果 各组COVID-19肺炎患者血清肾功能指标变化不明显,差异无统计学意义(P>0.05);危重组患者血清ALT和AST升高发生率分别为31.8%和45.5%,显著高于重型组(分别为4.6%和13.6%,P<0.05)或普通型组(0.0%和2.9%,P<0.05);危重组血清cTnT、Myo和CK-MB升高发生率分别为72.7%、45.5%和27.3%,显著高于重型组(分别为22.7%、16.6%和9.1%,P<0.05)或普通型组(分别为4.4%、1.5%和1.5%,P<0.05);24例心肌酶学异常患者病死率为25%,显著高于88例心肌酶学正常组的1.1%(P<0.05)。结论 单中心回顾性分析显示血清心肌酶学异常的新型冠状病毒肺炎患者病情可能比较危重,病死率比较高,需格外加强干预。     

甲状腺功能亢进症初诊患者肝功能异常的临床分析

探讨甲状腺功能亢进症(甲亢)初诊患者肝功能异常的发生率、临床特点及相关因素。将428例甲亢患者根据肝功能是否异常分为两组,分析其临床表现、肝功能指标与血清甲状腺激素水平以及甲状腺自身抗体的水平的关系。初诊甲亢患者肝功能异常的发生率为30．1％,肝功能损害最常见的是碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)增高,其甲状腺激素水平显著高于无肝功能异常者。而TSH、甲状腺微粒体抗体(TMA)、甲状腺球蛋白抗体(TGA)则无明显差异。甲亢初诊患者合并肝功能异常较常见,肝功能损害以ALP、ALT增高为最常见,且与甲状腺激素水平关系密切。     

艾迪注射液联合GP化疗方案对非小细胞肺癌患者的影响研究

目的分析艾迪注射液联合GP化疗方案对非小细胞肺癌(NSCLC)患者的影响。方法选取2012年1月—2014年5月渭南市中心医院收治的NSCLC患者68例,随机分为对照组35例与治疗组33例。对照组患者予以GP化疗方案,21 d为1个化疗周期;治疗组患者在对照组基础上加用艾迪注射液,连续治疗2周。比较两组患者临床疗效、毒副作用(恶心呕吐、白细胞计数下降、血小板计数下降、肝功能异常、肾功能异常)发生情况及治疗前后血常规指标(白细胞计数、血小板计数)、肝功能指标(丙氨酸氨基转移酶、天冬氨酸氨基转移酶)、肾功能指标(血肌酐、尿素氮)。结果两组患者临床疗效比较,差异无统计学意义(P0.05)。治疗组患者恶心呕吐、白细胞计数下降、血小板计数下降、肾功能异常发生率低于对照组(P0.05);两组患者肝功能异常发生率比较,差异无统计学意义(P0.05)。治疗前两组患者白细胞计数、血小板计数及丙氨酸氨基转移酶、天冬氨酸氨基转移酶、血肌酐、尿素氮水平比较,差异无统计学意义(P0.5);治疗后治疗组患者白细胞计数、血小板计数高于对照组,丙氨酸氨基转移酶、天冬氨酸氨基转移酶、血肌酐、尿素氮水平低于对照组(P0.05)。结论艾迪注射液联合GP化疗方案可减少NSCLC患者毒副作用。     

不同病情严重程度的新型冠状病毒肺炎患者凝血功能分析

目的:分析新型冠状病毒肺炎(COVID-19)患者的凝血指标情况及影响凝血功能的相关因素,为COVID-19患者抗凝治疗提供参考。方法:回顾性分析2020年2月初至3月,华中科技大学同济医学院附属协和医院西院区收治的COVID-19确诊患者123例,其中普通型组(n=39)、重型组(n=66)和危重型组(n=18)。比较三组患者的一般情况、凝血指标、Padua评分,分析影响患者凝血功能和病情程度的危险因素。结果:普通型组与重型组,普通型与危重型在年龄、Padua评分上差异有统计学意义;普通型组与危重型组,重型组与危重型组在D-Dimer水平差异有统计学意义。将普通型及重型+危重型按是否D-Dimer1.00μg/mL各分为两亚组,分析影响凝血指标因素,结果显示重型+危重型亚组患者在白蛋白、前白蛋白及谷丙转氨酶之间差异有统计学意义。结论:年龄、D-Dimer、VTE高危是COVID-19患者病情加重的危险因素,年龄越大、D-Dimer越高、VTE高危的患者病情越重,患者的凝血功能与肝功能相关。     

血生化及心肌酶学检测在早期发现老年支原体肺炎患者心肌损害中的临床价值

目的探讨老年肺炎支原体感染患者血生化及心肌酶学检测指标与普通老年肺炎患者之间的区别。方法选取2012年6月至2013年12月在该院治疗的45例60岁以上肺炎支原体感染患者为观察组,另选45例普通肺炎患者为对照组。采集两组患者静脉血,并对其总蛋白(TP)、丙氨酸氨基转移酶(ALT)、总胆红素(T-BIL)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)及天门冬氨酸氨基转移酶(AST)等指标进行检测对比。结果观察组患者ALT、CK-MB、LDH、AST等指标明显高于对照组(P<0.05)。结论老年肺炎支原体感染患者的心肌损害普遍重于普通肺炎患者,治疗期间应注意监测ALT、CK-MB、LDH、AST等指标,防止严重心肌损害的发生。     

COVID-19 and Indirect Liver Injury: A Narrative Synthesis of the Evidence

The liver is frequently affected by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection. The most common manifestations are mildly elevated alanine aminotransferase and aspartate aminotransferase, with a prevalence of 16-53% among patients. Cases with severe coronavirus disease 2019 (COVID-19) seem to have higher rates of acute liver dysfunction, and the presence of abnormal liver tests at admission signifies a higher risk of severe disease during hospitalization. Patients with chronic liver diseases also have a higher risk of severe disease and mortality (mainly seen in patients with metabolic-associated fatty liver disease). Several pathways of damage have been proposed in the liver involvement of COVID-19 patients; although, the end-cause is most likely multifactorial. Abnormal liver tests have been attributed to the expression of angiotensin-converting enzyme 2 receptors in SARS-CoV-2 infection. This enzyme is expressed widely in cholangiocytes and less in hepatocytes. Other factors attributed to liver damage include drug-induced liver injury, uncontrolled release of proinflammatory molecules (“cytokine storm”), pneumonia-associated hypoxia, and direct damage by the infection. Hepatic steatosis, vascular thrombosis, fibrosis, and inflammatory features (including Kupffer cell hyperplasia) are the most common liver histopathological findings in deceased COVID-19 patients, suggesting important indirect mechanisms of liver damage. In this translational medicine-based narrative review, we summarize the current data on the possible indirect mechanisms involved in liver damage due to COVID-19, the histopathological findings, and the impact of these mechanisms in patients with chronic liver disease.     

Sequential changes of serum aminotransferase levels in patients with severe acute respiratory syndrome

Severe acute respiratory syndrome (SARS) is a newly emerging infectious disease. To describe the hepatic injury caused by this disease, we report the sequential changes of serum transaminase in probable SARS patients during a hospital outbreak in southern Taiwan. From April to June, 2003, 52 probable SARS patients were hospitalized. Serial serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were retrospectively analyzed and hepatitis B surface antigen (HBsAg) was also evaluated to correlate with the progression of this disease. Fifty-three percent of the patients had abnormal liver function during hospitalization. More than 70% of abnormal transaminase levels were mildly elevated. Most elevated levels were noted during the second week after onset of fever. Neither transaminase elevation nor HBsAg was related to the prognosis of SARS, and only advanced age was an independent predictor of poor outcome. Our study suggested that coronavirus causing SARS might induce liver damage.     

小鼠严重急性呼吸综合征样模型相关肝脏损伤的研究

目的 通过动态监测小鼠严重急性呼吸综合征（SARS）样模型肝脏的组织病理学变化和病毒分布情况，进一步结合肝内凝血酶原酶（fg12）的表达和纤维素沉积现象来探讨SARS肝脏损伤的可能机制及其临床意义。方法实验组Balb／cJ近交系小鼠气管途径感染100PFU鼠肝炎3型病毒（MHV-3），平行设立0．9％氯化钠溶液对照组，动态观察感染后两组小鼠的一般情况、组织脏器的病理学改变和肝功能损伤情况。标准噬斑法和原位杂交技术检测实验组小鼠组织器官的病毒分布情况。结合感染后肝组织中纤维素的表达，分别从蛋白和基因转录水平探讨fg12作为一种促炎症因子在SARS肝损伤中的作用。结果实验组小鼠5d内死亡率高达100％，组织病理学观察发现病变可累及多个脏器，其中肝脏小叶结构基本完整，肝细胞弥漫混浊肿胀，大面积气球样变和水样变，汇管区少量淋巴细胞浸润，偶见中央静脉周围肝细胞的点灶状坏死；肺脏呈现典型间质性肺炎样改变伴透明膜、微小血栓形成；非特异性炎性改变亦见于脾脏、肾脏等其他脏器。噬斑试验和原位杂交显示病毒可侵犯所有收集的组织脏器。随着感染时间的延长，小鼠肝脏功能受损，fg12（mfg12）转录和表达可出现在感染肝脏的坏死区域，周围伴有纤维素沉积。对照组小鼠全部健康存活。结论利用MHV-3成功建立了小鼠SARS样模型，并提示其肝脏损伤在病理学改变和病变程度上均类似于人类SARS合并的非特异性肝炎，除病毒本身所致的肝细胞病变，mfg12在感染后肝组织中的特异性表达及其诱导的纤维素沉积可能是造成肝脏损伤的又一重要因素。     

Liver-spleen axis dysfunction in COVID-19

Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an acute infectious disease that spreads mainly through the respiratory route. Besides interstitial pneumonia, a number of other clinical manifestations were noticed in COVID-19 patients. In particular, liver and spleen dysfunctions have been described both as complications of COVID-19 and as potential predisposing factors for severe COVID-19. Liver damage is rather common in COVID-19 patients, and it is most likely multifactorial, caused by the direct insult of SARS-CoV-2 to the liver by the cytokine storm triggered by the virus, by the use of hepatotoxic drugs, and as a consequence of hypoxia. Although generally mild, liver impairment has been found to be associated with a higher rate of intensive care unit admission. A higher mortality rate was reported among chronic liver disease patients. Instead, spleen impairment in patients with COVID-19 has been poorly described. The main anatomical changes are the architectural derangement of the B cell compartment, white pulp atrophy, and reduction or absence of lymphoid follicles, while, from a functional point of view, the IgM memory B cell pool is markedly depleted. The outcome of COVID-19 in asplenic or hyposplenic patients is yet to be defined. In this review, we will summarise the current knowledge regarding the impact of SARS-CoV-2 on the liver and spleen function, as well as the outcome of patients with a pre-existent liver disease or defective spleen function.     

Serum hepatic enzyme manifestations in patients with severe acute respiratory syndrome： Retrospective analysis

AIM: To evaluate the hepatic function in patients with severe acute respiratory syndrome (SARS) and possible causes of hepatic disorder in these patients. METHODS: One hundred and eighty-two patients with SARS were employed in a retrospective study that investigated hepatic dysfunction. Liver alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactic dehydrogenase (LDH) were analyzed in these patients. Patients with different hospital treatments were further investigated. RESULTS: Of the 182 patients, 128(70.3%) had abnormal ALT activity, 57(31.3%) had abnormal AST activity and 87(47.8%) had abnormal LDH activity. The peak of elevated hepatic enzyme activities occurred between the sixth day and the tenth day after the first day of reported fever. Of the 182 patients, 160(87.9%) had been treated with antibiotics, 137(75.2%) with Ribavirin, and 115(63.2%) with methylpredisolone. There was no statistically significant correlation between the duration of Ribavirin treatment and hepatic dysfunction. CONCLUSION: Abnormal liver functions were common in patients with SARS and could be associated with virus replication in the liver.     

新型冠状病毒肺炎与肝功能损伤的关系初探:一项多中心研究

目的分析新型冠状病毒肺炎病例的临床特征,初步探讨不同临床分型与肝功能损伤的关系。方法纳入2020年1月23日到2020年2月8日7家新型冠状病毒感染定点医院连续收治的确诊病例。根据国家卫生健康委员会发布的《新型冠状病毒感染的肺炎诊疗方案(试行第五版修正版)》进行临床分型(轻型、普通型、重型、危重型)。研究数据采用SPSS19.0统计学软件进行分析。定量资料采用中位数(四分位数间距)表示,定性资料采用频数和率表示。两组数据之间的差异性分析采用秩和检验。结果纳入了符合标准的32例确诊病例,轻型或普通型28例(87.50%),重型或危重型4例(12.50%)。4例(12.50%)患者合并有1项基础疾病(支气管哮喘、冠心病、恶性肿瘤、慢性肝脏疾病各1例),1例(3.13%)患者同时合并有高血压和恶性肿瘤。实验室检查结果提示:总队列病例的丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)分别为26.98(16.88~46.09)U/L和24.75(18.71~31.79)U/L,白蛋白(Alb)和总胆红素(TBil)分别为39.00(36.20~44.20)g/L和16.40(11.34~21.15)μmol/L。轻型或普通型亚组的ALT和AST分别为22.75(16.31~37.25)U/L和23.63(18.71~26.50)U/L,其中ALT>40 U/L有6例(21.00%),AST>40 U/L有1例(3.60%);Alb和TBil分别为39.70(36.50~46.10)g/L和15.95(11.34~20.83)μmol/L。重型或危重型亚组的ALT和AST分别为60.25(40.88~68.90)U/L和37.00(20.88~64.45)U/L,其中ALT>40 U/L有3例(75.00%),AST>40 U/L有1例(25.00%);Alb和TBil分别为35.75(28.68~42.00)g/L和20.50(11.28~25.00)μmol/L。结论多中心回顾性研究结果提示新型冠状病毒肺炎合并肝功能损伤在轻型和普通型患者中少见,而在重型和危重型患者中多见。因此,应当加强对重症患者治疗期间的肝功能监测与评估。