451例新型冠状病毒感染患者合并肝损伤的发生情况及临床特征分析

目的 探讨新型冠状病毒肺炎（COVID-19）患者合并肝损伤的发生率，比较有肝损伤与无肝损伤患者的临床特征及转归情况。方法 以2020 年2 月19 日至3 月23 日在湖北省妇幼保健院光谷院区确诊的451 例COVID-19患者为研究对象，收集其个人基本信息、发病症状、既往病史、实验室检查及转归资料；根据入院时丙氨酸转氨酶、天冬氨酸转氨酶、碱性磷酸酶和总胆红素的异常情况将其分为无肝损伤组（n=338）和肝损伤组（n=113），其中肝损伤组又分为肝细胞（n=62）、胆汁淤积型（n=35）及混合型肝损伤（n=16），并运用方差分析、卡方检验、Kruskal-Wallis H检验比较各组上述各项指标的差异。结果 451例COVID-19 患者中，合并肝损伤总的发生率为25.1%，其中肝细胞型、胆汁淤积型、混合型肝损伤的发生率分别为13.7%、7.8%、3.5%。与无肝损伤组相比，肝损伤组的男性例数、气喘气短、肌肉酸痛和腹泻等症状的比例显著升高（P＜0.05）；肝损伤组中，肝细胞型和胆汁淤积型患者慢性心功能障碍的比例显著升高（P＜0.05）。在20项生化指标中，肝细胞型、胆汁淤积型和混合型肝损伤组分别有5项、8项和13项指标与无肝损伤组相比存在统计学差异（P＜0.05）；混合型肝损伤患者的超敏C-反应蛋白、血清IL-6、D-二聚体、肌酸激酶同工酶和肌红蛋白等指标相比于其他组升高2～10 倍不等（所有P＜0.05）。从转归来看，胆汁淤积型和混合型肝损伤组患者相比于其他组转为重症或危重症以及采用机械通气治疗的比例显著升高（P＜0.05）。结论 COVID-19合并肝损伤的比例在25%以上，其中合并胆汁淤积型及混合型肝损伤的患者更易转为重症或危重症。

Analysis of the basic situation and clinical characteristics of 451 patients with novel coronavirus infection complicated with liver injury

Objective To investigate the incidence, classification of the liver injury accompanied with new coronavirus pneumonia (COVID-19), as well as to compare clinical characteristics and outcome of patients with or without liver injuries. Methods A total of 451 patients diagnosed with COVID-19 in Hubei Maternal and Child Healthcare Hospital Guanggu Branch between Feb. 19, 2002 and Mar. 23, 2020 were included, the general clinical data, laboratory tests and outcome data were collected. Patients were divided into no liver damage group (n=338) and liver damage group (n=113) according to the values of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and total bilirubin detection at the time of admission, of which liver damage group was further divided into subgroups of hepatocyte type (n=62), cholestasis type (n=35) and mixed type (n=16); the general information, symptoms, underlying diseases, biochemical indicators and outcomes were analyzed with ANOVA, Kruskal-Wallis H test, Mann-Whitney U test and chi-square test. Results Of 451 patients with COVID-19, the total incidence of liver injury was 25.1%, within which the incidence of hepatocellular, cholestasis, and mixed liver damage were 13.7%, 7.8%, and 3.5%, respectively. Compared with those without liver damage, the proportions of males, breath shortness, muscle soreness, and diarrhea in liver damage group were significantly higer (P<0.05). Among liver damage group, the proportions with chronic cardiac dysfunction in the subgroups of cholestasis type and hepatocyte type significantly higher (P<0.05). Among the 20 biochemical indicators studied, compared with the non-hepatic damage group, there were 5, 8, and 13 kinds for hepatocyte, cholestatic, and mixed types to have significant differences respectively); hypersensitive C-reactive protein, serum IL-6, D-dimer, creatine kinase isoenzyme and myoglobin in patients with mixed liver lesions were increased by 2~10 times compared with other groups (P<0.05). From the perspective of outcome, patients with cholestasis and mixed liver damage were significant increased in the rate of conversion to severe or critically ill, the usage of mechanical ventilation (P<0.05). Conclusion The proportion of patients with COVID-19 complicated with liver injury is more than 25%, and patients with cholestasis and mixed liver damage are more likely to be severe or critically ill.