【摘要】 目的 探讨慢性乙型肝炎患者服用熊去氧胆酸后对新型冠状病毒感染（COVID-19）的潜在防治效果。方法 收集2022年1月—12月首都医科大学附属北京地坛医院324例慢性乙型肝炎患者的临床资料，根据是否服用熊去氧胆酸，分为熊去氧胆酸组和对照组。利用倾向性评分匹配法（PSM）平衡两组患者年龄、性别和慢性并发症等混杂因素，观察两组间SARS CoV-2感染率、COVID-19后症状和恢复时间的差异。对白细胞、血红蛋白、血小板、ALT、AST、Alb、ALP、TBil、甘油三酯（TG）、总胆固醇（TC）等实验室指标、疫苗接种情况和COVID-19后肝病症状的发生情况进行对比。计量资料符合正态性分布的两组间比较采用成组t检验；偏态分布两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ~2检验和连续校正χ~2检验。采用二元Logistic回归进行单因素分析和多因素分析，分析匹配后影响COVID-19的因素。结果 熊去氧胆酸组87例患者，对照组237例患者，PSM后熊去氧胆酸组为78例，对照组为137例，两组间平衡性良好。熊去氧胆酸组SARS CoV-2感染率为82.1%(64/78），对照组感染率为95.6%(131/137），差异有统计学意义（χ~2=10.847,P=0.001）。COVID-19后熊去氧胆酸组发生寒战（10.9%vs 38.9%，χ~2=16.124,P<0.001）、咳嗽（56.3%vs 74.8%，χ~2=6.889,P=0.009）的患者比例均小于对照组，差异具有统计学意义。COVID-19后熊去氧胆酸组患者恢复时间≤7天者比例达79.7%，对照组为61.1%，两组间差异具有统计学意义（χ~2=6.760,P=0.009）。单因素和多因素Logistic回归分析均显示熊去氧胆酸是COVID-19的独立影响因素（OR值分别为0.21、0.17,P值均<0.05）。结论 在慢性乙型肝炎患者中，服用熊去氧胆酸是COVID-19的保护因素，可一定程度上减轻相关症状，缩短恢复时间，在防治COVID-19方面具有重要价值。更多还原

【Abstract】 Objective To investigate the potential effect of ursodeoxycholic acid (UDCA) in the prevention and treatment of COVID-19 in patients with chronic hepatitis B.Methods Clinical data were collected from 324 patients with chronic hepatitis B who were treated in Beijing Ditan Hospital,Capital Medical University,from January to December 2022,and according to whether UDCA was administered,they were divided into UDCA group and control group.The propensity score matching (PSM) method was used to balance the confounding factors such as age,sex,and chronic complications,and the two groups were compared in terms of SARS-CoV-2 infection rate,symptoms,and recovery time after COVID-19.The two groups were also compared in terms of related laboratory markers (white blood cell count[WBC],hemoglobin[Hb],platelet count[PLT],alanine aminotransferase[ALT],aspartate aminotransferase[AST],albumin[Alb],alkaline phosphatase[ALP],total bilirubin[TBil],triglyceride[TG],and total cholesterol[TC]),vaccination,and the incidence rate of liver disease symptoms after COVID-19.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of data with skewed distribution between the two groups;the chi-square test and the continuously corrected chisquare test were used for comparison of categorical data between two groups.The binary Logistic regression model was used for univariate and multivariate analyses to investigate the influencing factors for COVID-19 after matching.Results There were 87patients in the UDCA group and 237 patients in the control group,and after PSM,there were 78 patients in the UDCA group and137 patients in the control group,with good balance between the two groups.There was a significant difference in SARS-CoV-2infection rate between the UDCA group and the control group[82.1%(64/78) vs 95.6%(131/137），χ~2=10.847,P=0.001].After COVID-19,compared with the control group,the UDCA group had a significantly lower proportion of the patients with chill(10.9%vs 38.9%，χ~2=16.124,P<0.001) and cough (56.3%vs 74.8%，χ~2=6.889,P=0.009).There was a significant difference between the UDCA group and the control group in the proportion of the patients with a recovery time of≤7 days after COVID-19(79.7%vs 61.1%，χ~2=6.760,P=0.009).Both univariate and multivariate logistic regression analyses showed that UDCA was an independent influencing factor for COVID-19 (odds ratio=0.21 and 0.17,both P<0.05).Conclusion UDCA is an protective factor against COVID-19 in patients with chronic hepatitis B and can alleviate related symptoms to some extent and shorten the recovery time,and therefore,it has an important value in the prevention and treatment of COVID-19.更多还原