ABSTRACT
Coronavirus disease 2019(COVID-19) refers to the pneumonia caused by novel coronavirus(2019-nCoV) infection in 2019. It is highly infectious, with quick spreading and a wide range of impact. It has been broken out in many countries around the world and has become a public health emergency of international concern. Chinese medicine has a long history in treating plague, and viral disease is the clinical advantage in Chinese medicine. Under the premise that there is currently no specific drug treatment, Chinese medicine has achieved certain effects in the treatment of COVID-19, which has attracted much attention and has been upgraded to a national strategy. Regarding the treatment of COVID-19 with Chinese medicine, it is believed that in terms of the name of Chinese medicine, the modern connotation of "uniform of typhoid and febrile disease" should be re-recognized, and it is advisable to use drugs based on specific clinical prescriptions and indications. In terms of pathogenesis, the COVID-19 has the pathogenesis rules including from the mild to severe conditions, from the surface to the inside, from the excess syndrome to the deficiency syndrome. We should pay attention to the Taiyang syndrome damaged by wet disease in initial stage, Shaoyang syndrome complicated with Yangming syndrome in the middle stage, phlegm-heat obstructing lung in critical period, lung and spleen deficiency in the recovery stage. In terms of clinical treatment strategies, Dayuan Yin is recommended to induce sweat and disperse the stasis in early stage. Xiaochaihu Decoction and Maxing Shigan Decoction is used to relieve both exterior and interior symptoms in middle stage. In critical stage, Tingli Dazao Xiefei Decoction, Weijing Decoction, Xuanbai Chengqi Decoction, Xiaoxianxiong Decoction, and Sanzi Yangqin Decoction are considered to reduce phlegm and clear heat. We should pay attention to nourishing Qi and strengthening the spleen by Zhuye Shigao Decoction, Sha-shen Maidong Decoction, and Liujunzi Decoction in the later recovery period. It shall be noted that, no matter in the initial mild stage, the middle and critical stages, or in the later recovery stage, Chinese medicine plays an important role, including preventing mild to severe disease, shortening the fever time, improving cough symptoms, increasing blood oxygen saturation and reducing mortality. Many studies have shown that the classical herbal formulae can alleviate the cytokine storm, regulate the immune imbalance, and produce the potential effect of synergistic treatment for COVID-19 through multiple components, multiple targets, and multiple pathways.
Subject(s)
Humans , COVID-19 , Drugs, Chinese Herbal/therapeutic use , Medicine, Chinese Traditional , SARS-CoV-2 , SyndromeABSTRACT
Resumen Introducción: La enfermedad renal aguda es una patología relativamente frecuente en pacientes con infección por COVID-19, en especial en el grupo de pacientes que se encuentran críticamente enfermos; los pacientes con enfermedad renal crónica se consideran un grupo de riesgo durante la pandemia debido a la inmunosupresión asociada por lo cual es importante la detección de infección por SARS CoV-2 en estos pacientes además de quienes están en diálisis y pacientes con trasplante renal. Es de suma importancia la identificación de enfermedad renal al ingreso de pacientes con COVID-19 pues se ha demostrado que representa un indicador para valorar supervivencia y pronóstico; varios estudios han establecido que la falla renal aguda se relaciona directamente con peor pronóstico y mortalidad. Debido al impacto positivo en la supervivencia que significa el manejo oportuno de la falla renal en pacientes positivos para COVID-19. Objetivo: Presentar la información científica actual sobre la fisiopatología de falla renal en contexto de COVID-19, diagnóstico, tratamiento, estrategias de seguimiento de la función renal durante la hospitalización, manejo de unidades de diálisis, indicación de líquidos intravenosos y manejo de shock en pacientes con enfermedad renal. Métodos: Se realizó una revisión de la literatura utilizando las bases de datos PubMed, Google Scholar y Embase; los criterios de selección incluían artículos que registraran el abordaje general y específico de complicaciones en el contexto de enfermedad renal, no se usaron filtros en la búsqueda. Conclusión: La falla renal en el contexto de la infección por COVID-19 representa un aspecto importante a estudiar dentro del desarrollo de la enfermedad y requiere consideraciones especiales para su manejo.
Abstract Introduction: Acute kidney disease is relatively frequent in COVID-19 patients, especially in critically ill patients; chronic kidney disease patients are consider as a risk group during COVID-19 pandemic because of immunosuppression associated with their condition, that's why it is important to detect SARS CoV-2 in this group of patients as in dialysis patients and kidney transplant patients. It is important to identify kidney disease at admission of COVID-19 patients because it has been shown that AKI or kidney disease represent an indicator to value survival and prognosis; literature have established that acute kidney injury is related with worst prognosis and mortality. Because of positive impact in survival that means timely and early treatment and follow up of kidney disease in COVID-19 patients. Objective: To presents actual scientific information about acute kidney injury physiopathology in COVID-19 patients, diagnosis, treatment, follow up strategies during hospitalization, management of dialysis units, intravenous liquids indications and shock management in patients with kidney disease. Methods: A literature review was performed using PubMed, Google Scholar and Embase databases; the selection criteria include articles that record the general and specific approach to complications in the context of kidney disease, no filters are used in the search. Conclusion: Renal failure in the context of COVID-19 infection represents an important aspect to study during development of COVID-19 infection and requires special considerations for its correct management.
Subject(s)
Humans , Male , Female , COVID-19 , Kidney Diseases , Patients , Renal Dialysis , Colombia , Peptidyl-Dipeptidase A , Acute Kidney Injury , HospitalizationABSTRACT
RESUMEN Introducción: el brote de la enfermedad causada por el coronavirus 2019 es una emergencia de salud pública con importancia internacional, situación de la que Cuba no escapa. Objetivo: caracterizar clínico-epidemiológicamente el evento epidemiológico por COVID-19 en la comunidad Camilo Cienfuegos, municipio Consolación del Sur, provincia Pinar del Río. Métodos: se realizó una investigación observacional, descriptiva, longitudinal y prospectiva, en el período comprendido entre marzo a mayo de 2020 en la comunidad Camilo Cienfuegos del municipio Consolación del Sur, declarada en cuarentena epidemiológica, con 10 casos confirmados de la enfermedad. Se confeccionó la araña epidemiológica, el cronopatograma y el mapa de ubicación de los casos positivos. Resultados: en la caracterización socio-demográficamente, predominó el sexo masculino, grupo etario de 0 a 19 años, modo de contagio introducido, la nacionalidad cubana, la evolución favorable de la enfermedad, y el período de incubación corto. Fueron descritas las acciones de salud implementadas en las primeras fases de enfrentamiento de la enfermedad. Conclusiones: el evento epidemiológico por COVID-19 fue caracterizado clínico- epidemiológicamente, se demostró la importancia de una adecuada implementación de los planes descritos para el control de la enfermedad, y la prevención desde la Atención Primaria de Salud, como herramienta fundamental.
ABSTRACT Introduction: the outbreak of coronavirus disease 2019 (COVID-19) is a public health emergency of international importance, a situation from which Cuba does not escape. Objective: to characterize clinical and epidemiologically the event caused by COVID-19 at Camilo Cienfuegos community in Consolación del Sur municipality, Pinar del Rio province. Methods: an observational, descriptive, longitudinal and prospective research was carried out during the period from March to May 2020 in the above-mentioned community, which was confirmed in epidemiological quarantine, with 10 confirmed cases of COVID-19. The epidemiological SPIDER search tool, the chronopathology and the map of the location of the positive cases were drawn up. Results: in the socio-demographic characterization of the community, male sex, the age group from 0 to 19 years old, way of transmission, Cuban citizens, the favorable evolution of the disease, and the short incubation period predominated. The health actions implemented in the first phases in order to deal with the disease were described. Conclusions: the epidemiological event caused by COVID-19 was clinical and epidemiologically characterized. The importance of an adequate implementation of the strategies described for the control of the disease was presented, where prevention actions from Primary Health Care are essential.
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@#An outbreak of new infectious disease caused by novel coronavirus （COVID- 19）started in China last year，which mainly leads to pulmonary injuries. The medical workers of the First Affiliated Hospital of Sun Yat-sen University quickly responded to the calls and three medical teams had been dispatched to epidemic area to join the fight against the novel coronavirus. The team creatively established the advanced life support units in general wards in order to rescue the critically ill patients. Hundreds of severe cases had been diagnosed and treated by our medical teams. To standardize the diagnosis and treatment of this new infectious disease ，especially the severe cases，guidelines for the diagnosis and management of COVID-19 is compiled by the First Affiliated Hospital of Sun Yat-sen University.
ABSTRACT
Severe cases infected with the coronavirus disease 2019 (COVID-19), named by the World Health Organization (WHO) on Feb. 11, 2020, tend to present a hypercatabolic state because of severe systemic consumption, and are susceptible to stress ulcers and even life-threatening gastrointestinal bleeding. Endoscopic diagnosis and treatment constitute an irreplaceable part in the handling of severe COVID-19 cases. Endoscopes, as reusable precision instruments with complicated structures, require more techniques than other medical devices in cleaning, disinfection, sterilization, and other reprocessing procedures. From 2016 to 2019, health care-acquired infection caused by improper endoscope reprocessing has always been among the top 5 on the list of top 10 health technology hazards issued by the Emergency Care Research Institute. Considering the highly infective nature of COVID-19 and the potential aerosol contamination therefrom, it is of pivotal significance to ensure that endoscopes are strictly reprocessed between uses. In accordance with the national standard “Regulation for Cleaning and Disinfection Technique of Flexible Endoscope (WS507-2016),” we improved the workflow of endoscope reprocessing including the selection of chemicals in an effort to ensure quality control throughout the clinical management towards COVID-19 patients. Based on the experience we attained from the 12 severe COVID-19 cases in our hospital who underwent endoscopy 23 times in total, the article provides an improved version of endoscopic reprocessing guidelines for bedside endoscopic diagnosis and treatment on COVID-19 patients for reference.
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At present, the 2019-novel coronavirus (2019-nCoV) is rampant all over the country, and controlling the spread of its epidemic has become a top priority. It is very difficult to control the epidemic spreading because there is no specific drug to fight against it. Therefore, it is urgent task for us to develop a specific drug as soon as possible, and attracting worldwide attention. The studies on anti-2019-nCoV drugs were generally carried out in three modes, as vaccine, chemical drugs and traditional Chinese medicine (TCM). Because the developing on vaccines and chemicals takes too long, it is hard to solve the urgent problem. Moreover, the RNA of coronavirus has been recombined so quickly that the vaccines and drugs studied with great efforts not only may miss the epidemic time, but also cannot be used in the next generation of new coronavirus treatment, as a result that the work of epidemic prevention is formidable. However, the prescriptions from traditional Chinese medicine theory can cure the epidemic disease, but how to develop it into a specific drug with clear chemical composition and clear pharmacologic mechanism, is also an urgent problem to be solved. In this paper, the new coronavirus and its drug development are reviewed, while the advantages and disadvantages are analyzed, and the drug dilemma research phenomenon is clarified by using the supramolecular “qi chromatography” theory. It is suggested that the strategy of anti-coronavirus drug developing should be put forward based on the impact of “qi chromatography” of biological supramolecular “imprinting template”, in order to develop new drugs against 2019-nCoV to control the spread of the epidemic as quick as we can, and establish a new research and development model of anti-coronavirus drug on integration of traditional Chinese and Western medicine, turning passive into active.
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@# There is no specific drug that has been approved for 2019-nCoV. There are a number of factors that pose major challenges in their development. Approaches to the development of anti-2019-nCoV include screening existing broad-spectrum antiviral drugs, repositioning of readily available clinical compounds, and <italic>de novo</italic> development of novel and specific agents for 2019-nCoV. Candidate compounds can be developed either to inhibit virus-based targets, such as RNA proteases, polymerase, spike glycoproteins, and viral envelop and membrane proteins, or to inhibit host-based targets, such as receptors and proteases that are utilized by virus for viral entry and endocytosis. Recently, the RNA polymerase remdesivir had demonstrated clinical efficacy in one patient with severe novel coronavirus pneumonia (NCP). The broad-spectrum viral protease inhibitor Kaletra<sup>®</sup> is also recommended in the current NCP clinical practice. Both drugs had lately been proceeded into multiple controlled phase III clinical trials to test their safety and efficacy in NCP. Combinational therapies consisting of multiple drugs provide other viable options against 2019-nCoV, based on scientific and clinical rationales. Using bioinformatics and database analysis, we have identified 75 clinically compounds, including 20 marketed compounds, that are efficacious in inhibiting key targets in virus- and host-based approaches, which may facilitate the development of new therapeutic options for 2019-nCoV.
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Objective@#To explore and analyze the possible mechanism of liver injury in patients with coronavirus disease 2019 (novel coronavirus pneumonia, NCP).@*Methods@#The correlation between ALT, AST and other liver enzyme changes condition and NCP patients’ disease status reported in the literature was comprehensively analyzed. ACE2 expression in liver tissue for novel coronavirus was analyzed based on single cell sequencing (GSE115469) data. RNA-Seq method was used to analyze Ace2 expression and transcription factors related to its expression in liver tissues at various time-points after hepatectomy in mouse model of acute liver injury with partial hepatectomy. t-test or Spearman rank correlation analysis was used for statistical analysis.@*Results@#ALT and AST were abnormally elevated in some patients with novel coronavirus infection, and the rate and extent of ALT and AST elevation in severe NCP patients were higher than those in non-severe patients. Liver tissue results of single cell sequencing and immunohistochemistry showed that ACE2 was only expressed in bile duct epithelial cells of normal liver tissues, and very low in hepatocytes. In a mouse model of acute liver injury with partial hepatectomy, Ace2 expression was down-regulated on the first day, but it was elevated up to twice of the normal level on the third day, and returned to normal level on seventh day when the liver recovered and hepatocyte proliferation stopped. Whether this phenomenon suggests that the bile duct epithelial cells with positive expression of Ace2 participate in the process of liver regeneration after partial hepatectomy deserves further study. In RNA-Seq data, 77 transcription factors were positively correlated with the expression of ACE2 (r > 0.2, FDR < 0.05), which were mainly enriched in the development, differentiation, morphogenesis and cell proliferation of glandular epithelial cells.@*Conclusion@#We assumed that in addition to the over activated inflammatory response in patients with NCP, the up-regulation of ACE2 expression in liver tissue caused by compensatory proliferation of hepatocytes derived from bile duct epithelial cells may also be the possible mechanism of liver tissue injury caused by 2019 novel coronavirus infection.
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The population is commonly susceptible to the 2019 novel coronavirus(2019-nCoV), especially the elderly with comorbidities.Elderly patients infected with 2019-nCoV tend to have higher rates of severe illnesses and mortality.Immunoaging is an important cause of severe novel coronavirus pneumonia(NCP)in the elderly.Due to the combination of underlying diseases, elderly patients may exhibit a typical manifestations in clinical symptoms, supplementary examinations and pulmonary imaging, deserving particular attention.The general condition of the elderly should be considered during diagnosis and treatment.In addition to routine care and measures such as oxygen therapy, antiviral therapy and respiratory support, treatment of underlying disease, nutritional support, sputum expectoration, complication prevention and psychological support should also be considered for elderly patients.Based on literature review and expert panel discussion, we drafted the Key Points for the Prevention and Treatment of the Novel Coronavirus Pneumonia in the elderly, aiming to provide help with the prevention and treatment of NCP and the reduction of harm to the elderly population.
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Background@#Medicines for the treatment of 2019-novel coronavirus (2019-nCoV) infections are urgently needed. However, drug screening using live 2019-nCoV requires high-level biosafety facilities, which imposes an obstacle for those without such facilities or 2019-novel coronavirus (2019-nCoV). This study aims to repurpose the clinically approved drugs for the treatment of coronavirus disease 2019 (COVID-19) in a 2019-nCoV related coronavirus model.@*Methods@#A 2019-nCoV related pangolin coronavirus GX_P2V/pangolin/2017/ Guangxi was described. Whether GX_P2X uses angiotensin-converting enzyme 2 (ACE2) as the cell receptor was investigated by using small interfering RNA (siRNA) -mediated silencing of ACE2. The pangolin coronavirus model was used to identify drug candidates for treating 2019-nCoV infection. Two libraries of 2406 clinically approved drugs were screened for their ability to inhibit cytopathic effects on Vero E6 cells by GX_P2X infection. The antiviral activities and antiviral mechanisms of potential drugs were further investigated. Viral yields of RNAs and infectious particles were quantified by quantitative real-time polymerase chain reaction (qRT-PCR) and plaque assay, respectively.@*Results@#The spike protein of coronavirus GX_P2V shares 92.2% amino acid identity with that of 2019-nCoV isolate Wuhan-hu-1, and uses ACE2 as the receptor for infection just like 2019-nCoV. Three drugs-cepharanthine (CEP), selamectin and mefloquine hydrochloride exhibited complete inhibition of cytopathic effects in cell culture at 10 μmol/L. CEP demonstrated the most potent inhibition of GX_P2V infection, with a concentration for 50% of maximal effect [EC50] of 0.98 μmol/L. The viral RNA yield in cells treated with 10 μmol/L CEP was 15,393-fold lower than in cells without CEP treatment ([6.48±0.02]×10-4 vs. 1.00±0.12, t=150.38, P<0.001) at 72 h post-infection (p.i.). Plaque assays found no production of live viruses in media containing 10 μmol/L CEP at 48 h p.i. Furthermore, we found CEP has potent antiviral activities against both viral entry (1.00±0.37 vs. 0.46±0.12, t=2.42, P<0.05) and viral replication (1.00±0.43 vs. [6.18±0.95]×10-4, t=3.98, P<0.05).@*Conclusions@#Our pangolin coronavirus GX_P2V is a workable model for 2019-nCoV research. CEP, selamectin and mefloquine hydrochloride are potential drugs for treating 2019-nCoV infection. Our results strongly suggest that CEP is a wide-spectrum inhibitor of pan-betacoronavirus, and clinical trial of CEP for treatment of 2019-nCoV infection is warranted.
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Background@#A novel coronavirus (2019-nCoV) causing an outbreak of pneumonia in Wuhan, Hubei province of China was isolated in January 2020. This study aims to investigate its epidemiological history, and analyzed the clinical characteristics, treatment regimens and prognosis of patients infected with 2019-nCoV during this outbreak.@*Methods@#Clinical data from 137 2019-nCoV-infected patients admitted to the respiratory departments of nine tertiary hospitals in Hubei province from December 30, 2019 to January 24, 2020 were collected, including general status, clinical manifestations, laboratory test results, imaging characteristics, and treatment regimens.@*Results@#None of the 137 patients (61 males, 76 females, aged 20-83 years, mean age 55 ± 16 years) had a definite history of exposure to Huanan Seafood Wholesale Market. Major initial symptoms included fever (112/137, 81.8%), coughing (66/137, 48.2%), and muscle pain or fatigue (44/137, 32.1%), with other, less typical initial symptoms observed at low frequency, including heart palpitations, diarrhea, and headache. Nearly 80% of the patients had normal or decreased white blood cell counts, and 72.3% (99/137) had lymphocytopenia. Lung involvement was present in all cases, with most chest computed tomography scans showing lesions in multiple lung lobes, some of which were dense; ground-glass opacity co-existed with consolidation shadows or cord-like shadows. Given the lack of effective drugs, treatment focused on symptomatic and respiratory support. Immunoglobulin G was delivered to some critically ill patients according to their condition. Systemic corticosteroid treatment did not show significant benefits. Notably, early respiratory support facilitated disease recovery and improved prognosis. The risk of death was primarily associated with age, underlying chronic diseases, and median interval from the appearance of initial symptoms to dyspnea.@*Conclusions@#The majority of patients with 2019-nCoV coronavirus pneumonia present with fever as the first symptom, and most of them still showed typical manifestations of viral pneumonia on chest imaging. Middle-aged and elderly patients with underlying comorbidities are susceptible to respiratory failure and may have a poorer prognosis.
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Objectives@#To analyze the epidemiological and clinical characteristics of children with 2019 novel coronavirus (2019-nCoV) infection in Shenzhen.@*Methods@#The data of 30 children diagnosed with 2019-nCoV infection in the Third People’s Hospital of Shenzhen from 16th January 2020 to 9th February 2020were collected.@*Results@#Among the 30 children, 14 were boys and 16 were girls. There were 10 mild cases, 13 common cases and one severe case, and six cases with asymptomatic infection. The age ranged from 7 months to 18 years old with the median age of 7 years old. Twenty out of 30 cases (66.7%) were school children. The common clinical characteristics were fever (30.0%, 9/30) and cough (23.3%, 7/30). The body temperature waved below 37.5 ℃. Mostly the auscultations of the lungs were no rales and there was no extrapulmonary complication. A total number of one case had wheezes and hypoxia, and one case had diarrhea and vomiting. There was no critical and death case. There were 29 cases with travelling experience in Hubei province within two weeks, and 24 cases (80.0%) had relatives (parents or grandparents) diagnosed with 2019-nCoV infection. Elevated white blood cell counts (﹥12×109/L), C reaction protein level, lactate dehydrogenase level and the low proportion of T help cells occurred in three, five, five and three cases, respectively. Some cases were coinfected with human respiratory syncytial virus, mycoplasma pneumonia, human herpesvirus, influenza B virus and rubella virus. The predominant pattern of computed tomography findings of childhood patients with 2019-nCoV infection presented with patchy film and ground-glass opacities in bilateral or unilateral lung. The median time for nucleic acid to turn negative was eight days among the enrolled cases. All the cases were cured and discharged home, and the days in hospital waved from 5 - 16 days (the median time was 12 days).@*Conclusions@#The majority of the childhood cases are the school-age children with family cluster. Most cases present mild and common symptoms with good prognosis. Some patients may be complicated with multiple infections.
ABSTRACT
Severe cases infected with the coronavirus disease 2019 (COVID-19), named by the World Health Organization (WHO) on Feb. 11, 2020, tend to present a hypercatabolic state because of severe systemic consumption, and are susceptible to stress ulcers and even life-threatening gastrointestinal bleeding. Endoscopic diagnosis and treatment constitute an irreplaceable part in the handling of severe COVID-19 cases. Endoscopes, as reusable precision instruments with complicated structures, require more techniques than other medical devices in cleaning, disinfection, sterilization, and other reprocessing procedures. From 2016 to 2019, health care-acquired infection caused by improper endoscope reprocessing has always been among the top 5 on the list of top 10 health technology hazards issued by the Emergency Care Research Institute. Considering the highly infective nature of COVID-19 and the potential aerosol contamination therefrom, it is of pivotal significance to ensure that endoscopes are strictly reprocessed between uses. In accordance with the national standard "Regulation for Cleaning and Disinfection Technique of Flexible Endoscope (WS507-2016)," we improved the workflow of endoscope reprocessing including the selection of chemicals in an effort to ensure quality control throughout the clinical management towards COVID-19 patients. Based on the experience we attained from the 12 severe COVID-19 cases in our hospital who underwent endoscopy 23 times in total, the article provides an improved version of endoscopic reprocessing guidelines for bedside endoscopic diagnosis and treatment on COVID-19 patients for reference.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Betacoronavirus , China , Coronavirus Infections , Diagnosis , Therapeutics , Cross Infection , Disinfection , Methods , Endoscopes , Virology , Equipment Contamination , Pandemics , Peracetic Acid , Personal Protective Equipment , Pneumonia, Viral , Diagnosis , Therapeutics , Sterilization , Methods , WorkflowABSTRACT
To explore and analyze the possible mechanism of liver injury in patients with coronavirus disease 2019 (novel coronavirus pneumonia, NCP). The correlation between ALT, AST and other liver enzyme changes condition and NCP patients' disease status reported in the literature was comprehensively analyzed. ACE2 expression in liver tissue for novel coronavirus was analyzed based on single cell sequencing (GSE115469) data. RNA-Seq method was used to analyze Ace2 expression and transcription factors related to its expression in liver tissues at various time-points after hepatectomy in mouse model of acute liver injury with partial hepatectomy. -test or Spearman rank correlation analysis was used for statistical analysis. ALT and AST were abnormally elevated in some patients with novel coronavirus infection, and the rate and extent of ALT and AST elevation in severe NCP patients were higher than those in non-severe patients. Liver tissue results of single cell sequencing and immunohistochemistry showed that ACE2 was only expressed in bile duct epithelial cells of normal liver tissues, and very low in hepatocytes. In a mouse model of acute liver injury with partial hepatectomy, Ace2 expression was down-regulated on the first day, but it was elevated up to twice of the normal level on the third day, and returned to normal level on seventh day when the liver recovered and hepatocyte proliferation stopped. Whether this phenomenon suggests that the bile duct epithelial cells with positive expression of Ace2 participate in the process of liver regeneration after partial hepatectomy deserves further study. In RNA-Seq data, 77 transcription factors were positively correlated with the expression of ACE2 (r > 0.2, FDR < 0.05), which were mainly enriched in the development, differentiation, morphogenesis and cell proliferation of glandular epithelial cells. We assumed that in addition to the over activated inflammatory response in patients with NCP, the up-regulation of ACE2 expression in liver tissue caused by compensatory proliferation of hepatocytes derived from bile duct epithelial cells may also be the possible mechanism of liver tissue injury caused by 2019 novel coronavirus infection.