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目的:分析四川地区重型新型冠状病毒肺炎(新冠肺炎)患者肝损伤的一般规律及抗病毒药物对肝功能的影响。方法:收集成都市公共卫生临床医疗中心2020年1月21日至2月24日收治的31例重型新冠肺炎患者的临床资料,包括人口学资料、临床表现及入重症监护病房(ICU)1周内肝功能指标,分析总结重型新冠肺炎患者病程中肝功能指标的变化规律,并进行分组分析。结果:共纳入30例临床资料比较完整的重型新冠肺炎患者。以老年男性人群的重型新冠肺炎发生率较高,30例患者中男性占60.0%;中位年龄61(47,79)岁,≥80岁者占23.3%;主要以发热(96.7%)、咳嗽(80.0%)和呼吸困难(66.7%)等呼吸道症状为主诉;ICU住院时间为(6.2±2.1)d。30例患者入ICU 1周内丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)及凝血酶原时间(PT)均有不同程度升高,白蛋白(ALB)降低。①根据是否服用洛匹那韦/利托那韦(克力芝)分为两组,结果显示,克力芝组(24例)患者入ICU 1周内肝功能指标异常率较非克力芝组(6例)普遍升高(7 d时ALT异常率:54%比33%,AST异常率:38%比33%,TBil异常率:8%比0%),但差异无统计学意义(均n P>0.05)。②根据服用克力芝剂量分为正常剂量组(500 mg、每日2次,19例)和减量组(250 mg、每日2次,5例),结果显示,克力芝减量较正常剂量对患者入ICU 1周内肝功能影响更小,其中减量组ALB、TBil在入ICU第2天时明显低于正常剂量组〔ALB(g/L):33.3±2.0比37.5±4.0,TBil(μmol/L):6.3±3.3比11.3±4.8,均n P 0.05). ② The patients were divided into normal dose group (500 mg, twice a day, n n = 19) and reduced dose group (250 mg, twice a day, n n = 5) according to the dosage of kaletra. It was shown that patients taking low-dose kaletra had a smaller effect on liver function within 1 week after ICU admission than those receiving normal dosage, and ALB, TBil in the reduced dose group were significantly lower than those in the normal dose group on the 2nd day after ICU admission [ALB (g/L): 33.3±2.0 vs. 37.5±4.0, TBil (μmol/L): 6.3±3.3 vs. 11.3±4.8, bothn P < 0.05].n Conclusions:Severe COVID-19 patients in Sichuan area suffered obvious liver damage in the early course of the disease and have a slower recovery. It is important to pay attention to avoid using drugs that can aggravate liver damage while treating the disease. If there is no alternative drug, liver protection treatment should be considered appropriately.