Objective: To study the changes in liver function and histopathology, and investigate the underlying mechanism and clinical significance of damage of liver in patients with severe acute respiratory syndrome (SARS).
Methods: According the clinical diagnostic standard of atypical pneumonia of Ministry of Health P. R. China, liver function was assessed in 110 SARS patients admitted from February 2003 to June 2003. Of them 8 SARS patients died, and the livers were pathologically examined, and their liver function parameters were compared with that of the 35 healthy controls.
Results: Alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), total bilirubin (TBil) of patients with SARS were higher than those of controls, they were (91.61+/-50.53) U/L vs. (32.91+/-10.56) U/L, (78.68+/-33.32) U/L vs. (29.43+/-8.89) U/L, (429.95+/-188.94) U/L vs. (200.83+/-44.86) U/L, (11.67+/-4.26) micromol/L vs. (8.44+/-3.86) micromol/L, all P<0.001. Albumin (ALB) and pro-albumin (PAB) of patients with SARS were lower than those of controls, they were (34.40+/-5.13) g/L vs. (42.09+/-6.79) g/L, (0.20+/-0.06) g/L vs. (0.34+/-0.05) g/L, both P<0.001. Direct reaction bilirubin (DBil), total bile acid (TBA), gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) showed no marked difference between SARS patients and controls, all P>0.05. Non-specific inflammation in the liver was observed in pathological examination in 4 cases. ALT, AST, GGT and LDH were always 4 to 9 times of normal. The ratio of abnormality of ALT, AST and PAB were more than 80.0 percent, the ratio of abnormality of ALB was 42.7 percent, and less than 30.0 percent for other indexes. The average of LDH, ALT, and AST of dead patients were higher than those of the survivors. Histopathology of liver was non-specific hepatitis.
Conclusion: The patients with SARS are prone to have mild non-specific hepatitis. It seldom causes the typical symptoms of hepatitis and it is easy to be ignored in clinic.