Objective: To investigate the clinical features and influencing factors of liver function injury in patients with 2019-nCoV/SARS-CoV-2 Omicron mutant strains. Methods: 1 183 confirmed imported cases of SARS-CoV-2 who were admitted at Shanghai Public Health Clinical Center (affiliated to Fudan University) from July 1, 2021 to January 15, 2022 were collected. Clinical data, viral genotyping and laboratory test results were collected to retrospectively analyze the basic condition and clinical characteristics of liver function injury. Statistical analysis was performed using t-test or Wilcoxon rank-sum test, χ2 test or Fisher's exact test, Pearson correlation test and logistic regression analysis. Results: 125 (10.6%) cases had raised baseline ALT level and 60 (5.1%) cases had abnormal baseline AST level. Among them, 33 cases (2.8%) had received hepatoprotective drugs. Liver function injury was generally mild in SARS-CoV-2 infection and minimal in Omicron mutant strains. Leukocyte count was increased in patients with raised alanine aminotransferase (ALT) [(6.96±1.78)×109/L vs. (6.41±1.96)×109/L, P=0.005 2], CT scan showed the proportion of liver hypodensity was significantly increased (2.4% vs. 0.3%, P=0.018 0). High-sensitivity C-reactive protein [(7.83±22.36) mg/L vs. (2.68±6.21) mg/L, P=0.007 8] and D-dimer [(0.34±0.39) μg/ml vs. (0.31±0.75) μg/ml, P=0.047 5] levels were higher in patients with raised AST than normal group. 26 cases had normal liver function at hospital admission; however, abnormal liver function was occurred during the course of the disease. Another 8 patients had abnormal liver function at hospital admission, and reduced liver function further during the course of treatment. Recovery time and length of hospital stay was significantly affected in patients with worsened liver function. Baseline body mass index value [odds ratio (OR)]=1.80, P=0.047), non-Omicron strains (OR=12.63, P=0.046), D-dimer (OR=2.36, P=0.047) and interleukin-6 levels (OR=1.03, P=0.009), and those who used glucocorticoids and/or ulinastatin after hospital admission (OR=6.89, P=0.034) had a higher risk of worsening liver function. Conclusions: Liver dysfunction could be observed among COVID-19 patients. Patients infected with omicron variant generally showed mild liver injury. Dynamic monitoring of liver function is necessary, especially among those with baseline elevated IL-6, D-Dimer level and use of antiinflammation medication during treatment.
目的： 探讨新型冠状病毒奥密克戎突变株感染者肝功能损害的临床特征及其影响因素。 方法： 纳入于2021年7月1日至2022年1月15日于上海市（复旦大学附属）公共卫生临床中心连续收治的1 183例境外输入新型冠状病毒肺炎确诊病例，收集临床资料、病毒基因分型以及实验室检查结果，回顾性分析肝功能损害的基本情况及临床特征。采用t检验或Wilcoxon秩和检验、χ２检验或Fisher确切概率法，Pearson相关性检验，logistic线性回归分析进行统计学分析。 结果： 有125例（10.6%）患者基线丙氨酸转氨酶（ALT）水平升高和60例（5.1%）基线天冬氨酸转氨酶（AST）水平异常，其中33例（2.8%）患者接受了保肝药物治疗。新型冠状病毒感染者肝功能损害通常较轻，其中奥密克戎突变株肝功能损伤更轻。ALT升高组患者的白细胞计数有所升高［（6.96±1.78）×109/L比（6.41±1.96）×109/L，P=0.005 2］；CT提示肝脏密度减低的比例显著升高（2.4%比0.3%，P=0.018 0）；AST升高患者中，超敏C反应蛋白［（7.83±22.36）mg/L比（2.68±6.21）mg/L，P=0.007 8］、D二聚体水平［（0.34±0.39）μg/ml比（0.31±0.75）μg/ml，P=0.047 5］高于正常组。26例患者入院时肝功能正常，病程中出现肝功能异常；另有8例患者入院时肝功能有异常，治疗过程中进一步进展。肝功能进展患者显著影响康复时间和住院天数。基线体质量指数值［比值比（OR）=1.80，P=0.047）］、非奥密克戎病毒株（OR=12.63，P=0.046）、D二聚体（OR=2.36，P=0.047）和白细胞介素-6水平（OR=1.03，P=0.009），以及入院后有使用糖皮质激素和/或乌司他丁者（OR=6.89，P=0.034）肝功能进展风险较高。 结论： 新型冠状病毒肺炎患者有部分存在肝功能受损，奥密克戎突变株相关的肝功能异常相对少见。新型冠状病毒诊疗中需对肝功能进行评估，尤其是对基线白细胞介素-6、D-二聚体水平升高，或入院后使用糖皮质激素和/或乌司他丁的患者。.