摘要
目的 探讨新型冠状病毒肺炎(COVID-19)对肝硬化患者病情进展及预后的影响。方法 收集2022年10月31日-2023年3月10日甘肃省人民医院收治的115例肝硬化患者,根据是否合并COVID-19分为肝硬化伴COVID-19组(n=31)及单纯肝硬化组(n=84)。比较两组患者生化、凝血、血常规等相关指标及肝硬化失代偿相关并发症,通过肝功能Child-Turcotte-Pugh(CTP)分级、终末期肝病血清钠模型(MELD-Na)评分、查尔森合并症指数(CCI)及慢性肝衰竭-序贯器官衰竭(CLIF-SOFA)评分评估两组患者肝脏储备功能及肝外合并症情况;利用COX回归分析与肝硬化伴COVID-19患者30 d死亡相关的因素。结果 与单纯肝硬化组比较,肝硬化伴COVID-19组患者天门冬氨酸氨基转移酶(AST)升高[48.00(31.00~104.00)U/L vs.35.50(24.00~55.75)U/L]、白蛋白(ALB)下降[(27.26±5.84)g/L vs.(31.67±5.81)g/L]、国际标准化比值(INR)升高[1.56(1.20~1.83)vs.1.26(1.14~1.47)],差异均有统计学意义(U/t=1 622.00、3.56、1 758.50,P均<0.05);肝硬化伴COVID-19组患者自发性腹膜炎发生率较高(19.35%vs.2.38%),中性粒细胞百分比[(70.02±15.19)%vs.(62.21±13.00)%]及白细胞介素-6(IL-6)[67.64(28.28~167.60)pg/mL vs.30.25(8.85~59.19)pg/mL]等炎症指标显著升高,差异均有统计学意义(χ^(2)/U/t=10.08、-2.73、254.50,P均<0.05);肝硬化伴COVID-19组患者中CTP分级为C的比例更高(61.23%vs.28.57%),且具有更高的CLIF-SOFA评分[6(4~9)分vs.4(2~5)分]、MELD-Na评分[(18.42±8.01)分vs.(14.60±6.21)分]、CCI[7(6~9)vs.6(5~7)]及死亡率(25.81%vs.4.76%),差异均有统计学意义(χ^(2)/U/t=10.36、1 095.50、-2.42、1 855.50、10.73,P均<0.05)。经COX回归分析,CCI(HR=2.77,95%CI:1.09~7.03,P=0.03)及CLIF-SOFA评分(HR=4.24,95%CI:1.33~13.50,P=0.01)可作为肝硬化伴COVID-19患者死亡的预测因子。结论 COVID-19可引起肝硬化患者肝功能恶化及肝外器官衰竭的进展,增加30 d死亡风险,呼吸衰竭是其最主要的死亡原因。
Objective To investigate the effect of corona virus disease 2019(COVID-19)on the progression and prognosis of patients with liver cirrhosis.Methods A total of 115 patients with cirrhosis admitted to the Gansu Provincial People's Hospital from October 31,2022 to March 10,2023 were collected and divided into cirrhosis with COVID-19 group(n=31)and simple cirrhosis group(n=84).The biochemical,coagulation,blood routine and other related indexes and complications related to liver cirrhosis decompensation were compared between the two groups,and the liver reserve function and extrahepatic comorbidities of the two groups were evaluated by Child-Turcotte-Pugh(CTP)grade,model for end-stage liver disease-Na(MELD-Na)score,Charlson comorbidity index(CCI)and chronic liver failure-sequential organ failure assessment(CLIF-SOFA)score.COX regression was used to analyze factors associated with 30-day death in patients with cirrhosis and COVID-19.Results Compared with the simple cirrhosis group,patients in cirrhosis combined with COVID-19 group had higher aspartate aminotransferase(AST)[48.00(31.00-104.00)U/L vs.35.50(24.00-55.75)U/L],lower albumin(ALB)[(27.26±5.84)g/L vs.(31.67±5.81)g/L],and higher international normalized ratio(INR)[1.56(1.20-1.83)vs.1.26(1.14-1.47)],with statistically significant differences(U/t=1 622.00,3.56,1 758.50,all P<0.05);Patients in cirrhosis combined with COVID-19 group had a higher incidence of spontaneous peritonitis(19.35% vs.2.38%),and inflammatory markers such as the percentage of neutrophils[(70.02±15.19)% vs.(62.21±13.00)%]and interleukin-6(IL-6)[67.64(28.28-167.60)pg/mL vs.30.25(8.85-59.19)pg/mL]were significantly higher,with statistically significant differences(χ^(2)/U/t=10.08,-2.73,254.50;all P<0.05);Patients with cirrhosis combined with COVID-19 group had a higher proportion of CTP Class C(61.23% vs.28.57%)and higher CLIF-SOFA score[6(4-9)score vs.4(2-5)score],MELD-Na score[(18.42±8.01)score vs.(14.60±6.21)score],CCI[7(6-9)vs.6(5-7)]and mortality rate(25.81% vs.4.76%),with statistical
作者
周妮
王源媛
郭思琪
麦平
ZHOU Ni;WANG Yuanyuan;GUO Siqi;MAI Ping(Jiangsu University School of Medicine,Zhenjiang,Jiangsu 212000,China;Department of Gastroenterology,Gansu Provincial Hospital,Lanzhou,Gansu 730030,China;The First Clinical Medical College of Gansu University of Traditional Chinese Medicine,Lanzhou,Gansu 730030,China)
出处
《热带医学杂志》
CAS
2024年第3期365-370,共6页
Journal of Tropical Medicine
基金
国家自然科学基金(81960107)。
