2020年 · 第100卷第28期

The novel coronavirus pneumonia (COVID-19) is a newly discovered class of infectious diseases that have spread globally. COVID-19 is caused by infection with SARS-CoV-2, which infects cells with angiotensin-converting enzyme II (ACE2) as a receptor. COVID-19 is dominated by respiratory lesions, and can involve multiple systems and organs such as kidneys, liver, heart, and blood. This disease is mainly transmitted through respiratory droplets and direct contact. Aerosol transmission is possible in a closed environment, and feces and urine may cause environmental pollution. Its incubation period is generally 1~14 days (mostly 3~7 days). This disease is generally susceptible in the population, and chronic kidney disease (CKD), especially dialysis patients, are also potentially susceptible populations. 16% ~20% of COVID-19 patients are clinically critically ill. Kidney involvement is often manifested as acute kidney injury (AKI) and proteinuria, and the occurrence of kidney injury has an important impact on the prognosis of COVID-19 patients^[1]。

The World Health Organization declared novel coronavirus pneumonia (COVID-19) a pandemic in 2020. Patients with metabolism-related fatty liver disease (MAFLD) often have other metabolic risk factors such as obesity and hypertension that may exacerbate COVID-19. To explore the association between MAFLD and COVID-19 severity, the study continuously enrolled 214 COVID-19 patients aged 18 to 75 years, and the diagnosis was confirmed by high-throughput sequencing of oropharyngeal swab specimens or real-time reverse transcription PCR. According to the international expert consensus on MAFLD in 2020, and the included patients were screened for fatty liver by abdominal CT to diagnose the presence or absence of MAFLD. The study finally included 66 patients with MAFLD who were divided into obese groups based on the presence or absence of obesity (n=45) versus non-obese group (n=21）。 The enrolled patients were divided into severe and non-severe groups according to China's "Novel Coronavirus Pneumonia Diagnosis and Treatment Plan (Trial 7th Edition)", and received standard treatment. The results showed that compared with the non-obese group, patients in the obese group had higher levels of aspartate aminotransferase, lower fasting blood glucose, low-density lipoprotein, lymphocyte counts, and more severe COVID-19 (37.5% vs 9.5%,P=0.021）。 The results of logistic regression analysis showed that among patients with MAFLD, obese people had an approximately 6-fold increased risk of severe COVID-19 compared with non-obese people (OR=5.77，95%CI：1.19~27.91，P =0.029）； Obesity remained independently associated with COVID-19 severity after adjusting for the confounders age, sex, smoking, diabetes, hypertension, and dyslipidemia (OR=6.32，95%CI：1.16~34.54，P=0.033）。