新型冠状病毒肺炎患者肝功能异常的影响因素及其在不同药物治疗中的动态变化

doi:10.3969/j.issn.1006-7795.2022.03.017

摘要/Abstract

摘要： 目的探讨新型冠状病毒肺炎 (以下简称新冠肺炎)患者肝功能异常的影响因素和住院期间不同药物治疗中肝功能的动态演变。方法根据基线肝功能水平将纳入的615例新冠肺炎患者分为肝功能异常组(225例)和肝功能正常组(390例),动态监测患者肝功能指标,采用Logistic回归分析筛选影响肝功能异常的独立危险因素。评估洛匹那韦/利托那韦、法维拉韦、磷酸氯喹、抗生素和银丹解毒颗粒等不同药物对肝功能水平的影响。结果肝功能异常的危险因素包括年龄、从发病到入院的天数、C反应蛋白和D-二聚体。与非重症组相比,重症组患者表现出显著升高的基线丙氨酸氨基转移酶(alanine aminotransferase, ALT)和门冬氨酸氨基转移酶(aspartate aminotransferase, AST)浓度和较低的血清白蛋白(serum albumin, ALB)浓度。179例患者在住院期间发生了肝功能异常,在入院第7天,抗病毒组患者的ALT和AST浓度明显低于非抗病毒组的患者(P=0.020 和P=0.033)。结论肝功能异常患者进展为重症新冠肺炎的风险较高。入院后,使用洛匹那韦/利托那韦和磷酸氯喹显著降低了ALT和AST浓度。本研究未发现使用抗病毒药物、抗生素或银丹解毒颗粒对肝造成损害。

关键词: SARS-CoV-2, 肝功能异常, 肝损伤, 重症, 抗病毒药物, 抗生素, 银丹解毒颗粒

Abstract: Objective To analyze the influencing factors of abnormal liver function in patients with COVID-19 and the dynamic changes of liver function during hospitalization with different drug treatments. Methods A total of 615 COVID-19 patients were enrolled in this study. According to the baseline liver function, they were divided into two groups: abnormal liver function (225 cases) and normal liver function (390 cases).Liver function was dynamically monitored and Logistic regression analysis was used to screen for independent risk factors affecting abnormal liver function. The effects of lopinavir/ritonavir, faveravir, chloroquine phosphate, antibiotics and Yindan Jiedu Granules (YDJDG) on liver function were evaluated. Results The risk factors for abnormal liver function included age, days from onset to admission, C-reactive protein and D-dimer. The severe group showed significantly higher baseline alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels and lower serum albumin (ALB) levels than the non-severe group. A total of 179 patients developed abnormal liver function during hospitalization. On day 7, the ALT and AST levels in the antiviral group were significantly lower than those in the non-antiviral group (P=0.020 and P=0.033). Conclusion Patients with abnormal liver function are at higher risk of progressing to severe COVID-19. After admission, lopinavir/ritonavir and chloroquine phosphate significantly reduced ALT and AST levels. In this study, no obvious damage to the liver was found from the use of antiviral drugs, antibiotics or YDJDG.

Key words: SARS-CoV-2, abnormal liver function, liver injury, severe, antiviral drugs, antibiotics, Yindan Jiedu Granules

中图分类号:

R563.1

刘遥, 冯颖, 任婕, 王宪波. 新型冠状病毒肺炎患者肝功能异常的影响因素及其在不同药物治疗中的动态变化[J]. 首都医科大学学报, 2022, 43(3): 433-439.

Liu Yao, Feng Ying, Ren Jie, Wang Xianbo. The influencing factors of abnormal liver function in patients with COVID-19 and its dynamic changes in different drug treatments[J]. Journal of Capital Medical University, 2022, 43(3): 433-439.

参考文献

[1] Fox S E, Akmatbekov A, Harbert J L, et al. Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans[J]. Lancet Respir Med, 2020, 8(7): 681-686.
[2] Varga Z, Flammer A J, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19[J]. Lancet, 2020, 395(10234): 1417-1418.
[3] Ackermann M, Verleden S E, Kuehnel M, et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in COVID-19[J]. N Engl J Med, 2020, 383(2): 120-128.
[4] Barton L M, Duval E J, Stroberg E, et al. COVID-19 autopsies, Oklahoma, USA[J]. Am J Clin Pathol, 2020, 153(6): 725-733.
[5] Shi S B, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China[J]. JAMA Cardiol, 2020, 5(7): 802-810.
[6] Guo T, Fan Y Z, Chen M, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19)[J]. JAMA Cardiol, 2020, 5(7): 811-818.
[7] Ni W T, Yang X W, Liu J, et al. Acute myocardial injury at hospital admission is associated with all-cause mortality in COVID-19[J]. J Am Coll Cardiol, 2020, 76(1): 124-125.
[8] Nepal G, Rehrig J H, Shrestha G S, et al. Neurological manifestations of COVID-19: a systematic review[J]. Crit Care, 2020, 24(1): 421.
[9] Alqahtani S A, Schattenberg J M. Liver injury in COVID-19: the current evidence[J]. United European Gastroenterol J, 2020, 8(5): 509-519.
[10] Gabarre P, Dumas G, Dupont T, et al. Acute kidney injury in critically ill patients with COVID-19[J]. Intensive Care Med, 2020, 46(7): 1339-1348.
[11] Cheng Y C, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19[J]. Kidney Int, 2020, 97(5): 829-838.
[12] Pei G C, Zhang Z G, Peng J, et al. Renal involvement and early prognosis in patients with COVID-19 pneumonia[J]. J Am Soc Nephrol, 2020, 31(6): 1157-1165.
[13] Klok F A, Kruip M J H A, Van Der Meer N J M, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19[J]. Thromb Res, 2020, 191: 145-147.
[14] Magro C, Mulvey J J, Berlin D, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases[J]. Transl Res, 2020, 220: 1-13.
[15] Helms J, Tacquard C, Severac F, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study[J]. Intensive Care Med, 2020, 46(6): 1089-1098.
[16] Gupta A, Madhavan M V, Sehgal K, et al. Extrapulmonary manifestations of COVID-19[J]. Nat Med, 2020, 26(7): 1017-1032.
[17] Bertolini A, Van De Peppel I P, Bodewes F A J A, et al. Abnormal liver function tests in patients with COVID-19: relevance and potential pathogenesis[J]. Hepatology, 2020, 72(5): 1864-1872.
[18] Wang Y J, Liu S H, Liu H Y, et al. SARS-CoV-2 infection of the liver directly contributes to hepatic impairment in patients with COVID-19[J]. J Hepatol, 2020, 73(4): 807-816.
[19] Kucharski A J, Russell T W, Diamond C, et al. Early dynamics of transmission and control of COVID-19: a mathematical modelling study[J]. Lancet Infect Dis, 2020, 20(5): 553-558.
[20] Xu L, Liu J, Lu M J, et al. Liver injury during highly pathogenic human coronavirus infections[J]. Liver Int, 2020, 40(5): 998-1004.
[21] Chen N S, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study[J]. Lancet, 2020, 395(10223): 507-513.
[22] Cai Q X, Huang D L, Ou P C, et al. COVID-19 in a designated infectious diseases hospital outside Hubei Province, China[J]. Allergy, 2020, 75(7): 1742-1752.
[23] Cai Q X, Huang D L, Yu H, et al. COVID-19: abnormal liver function tests[J]. J Hepatol, 2020, 73(3): 566-574.
[24] Phipps M M, Barraza L H, LaSota E D, et al. Acute liver injury in COVID-19: prevalence and association with clinical outcomes in a large U.S. cohort[J]. Hepatology, 2020, 72(3): 807-817.