Objective: To analyze whether there are differences and related influencing factors in liver injury associated with different strains of 2019-nCoV/SARS-CoV-2 infection. Methods: Data of epidemiology, clinical symptoms, laboratory tests, and treatment outcomes of patients with COVID-19 infection confirmed with Alpha and Delta virus strain in Zhejiang Province were retrospectively collected. Statistical analysis was performed using independent samples t-test or Mann-Whitney U test, χ2 test or Fisher's exact test, and logistic regression analysis. Results: A total of 788 and 381 cases with Alpha and Delta virus strain were included. Vaccination ratio was 0% in Alpha and 85.30% in Delta group (P<0.001), The proportion of patients with fever (80.71% vs. 40.94%, P<0.001) was significantly higher in Alpha than Delta strain group. The proportion of critical ill patients was significantly higher in Delta group (9.90% vs. 1.57%, respectively, P<0.001). The virus negative conversion time was significantly longer in Delta than Alpha group (22 d vs. 11 d, P<0.001), but the incidence of liver injury was significantly higher in Alpha than Delta group (20.05% vs. 13.91%, P=0.011). Univariate analysis showed that Alpha virus strain infection, male sex, body mass index, chronic liver disease, fever, diarrhea, shortness of breath, severe/critical illness, elevated creatine kinase (CK), elevated international normalized ratio (INR) and an elevated neutrophil/lymphocyte ratio was significantly associated with an increased risk of liver injury occurrence, and in patients with pharyngeal pain the risk of liver injury occurrence was significantly reduced. Multivariate analysis showed that shortness of breath [OR, 2.667 (CI: 1.389-5.122); P=0.003], increased CK [OR, 2.544 (CI: 1.414-4.576); P=0.002] and increased INR [OR, 1.721] (CI: 1.074-2.758); P=0.024] was significantly associated with an increased risk of liver injury occurrence, and in patients with pharyngeal pain the risk of liver injury occurrence was significantly reduced [OR, 0.424 (CI: 0.254-0.709); P=0.001]. Conclusion: Although the virulence of the Delta is stronger than Alpha strain, most patients infected with Delta strain vaccinated against COVID-19 in Zhejiang province had milder clinical symptoms and a lower incidence and degree of liver injury. Notably, the infection risk even remains after vaccination; however, symptoms and the incidence of severe and critical illness can be significantly reduced.
目的： 分析不同新型冠状病毒肺炎（COVID-19）病毒株感染相关肝损害是否存在差异以及肝损害的相关影响因素。 方法： 回顾性收集浙江省确诊的阿尔法病毒株和德尔塔变异株感染的COVID-19患者的流行病学、临床症状、实验室检查以及治疗转归的资料，比较2组肝损害发生率，分析肝损害的影响因素。采用独立样本的t检验或Mann-Whitney U、χ2检验或Fisher精确检验，logsitic回归分析进行统计学分析。 结果： 共纳入了阿尔法病毒株感染患者788例，德尔塔变异株感染者381例。阿尔法组患者接种疫苗的比例为0，而德尔塔组接种疫苗比例为85.30%（P<0.001），阿尔法组患者发热（80.71%比40.94%，P<0.001）比例显著高于德尔塔组、发生危重症的比例显著高于德尔塔组，分别为9.90%和1.57%（P<0.001），德尔塔组病毒转阴时间显著长于阿尔法组（22 d比11 d，P<0.001），阿尔法组患者肝损害的发生率显著高于德尔塔组（20.05%比13.91%，P=0.011）。单因素分析发现肝脏损害风险增加与阿尔法病毒株感染、男性、体质量指数、慢性肝病、发热、腹泻、气促、重症/危重症、肌酸激酶（CK）升高、国际标准化比值（INR）升高和中性粒细胞/淋巴细胞比值升高显著相关，而有咽痛症状的患者发生肝损害的风险显著降低。多因素分析发现气促［OR，2.667（CI：1.389～5.122）；P=0.003］、CK升高［OR，2.544（CI：1.414～4.576）；P=0.002］和INR升高［OR，1.721（CI：1.074～2.758）；P=0.024］是肝损害高危因素，而有咽痛症状［OR，0.424（CI：0.254～0.709）；P=0.001］患者发生肝脏损害的风险降低。 结论： 虽然德尔塔变异株毒力比阿尔法病毒株强，但是浙江省感染德尔塔变异株的患者大部分接种过COVID-19疫苗，临床症状更轻，且肝脏损害的发生率及程度也更低。疫苗接种后虽然仍有感染的风险，但是可以减轻症状，显著降低重症和危重症的发生率。.