Institute of Liver disease and Transplantation, Dr Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India.
Institute of Liver disease and Transplantation, Dr Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India.
J Hepatol. 2020 Nov;73(5):1231-1240. doi: 10.1016/j.jhep.2020.06.006. Epub 2020 Jun 15.
The current coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has become a major public health crisis over the past few months. Overall case fatality rates range between 2-6%; however, the rates are higher in the elderly and those with underlying comorbidities like diabetes, hypertension and heart disease. Recent reports showed that about 2-11% of patients with COVID-19 had underlying chronic liver disease. During the previous SARS epidemic, around 60% of patients were reported to develop various degrees of liver damage. In the current pandemic, hepatic dysfunction has been seen in 14-53% of patients with COVID-19, particularly in those with severe disease. Cases of acute liver injury have been reported and are associated with higher mortality. Hepatic involvement in COVID-19 could be related to the direct cytopathic effect of the virus, an uncontrolled immune reaction, sepsis or drug-induced liver injury. The postulated mechanism of viral entry is through the host angiotensin-converting enzyme 2 (ACE2) receptors that are abundantly present in type 2 alveolar cells. Interestingly, ACE2 receptors are expressed in the gastrointestinal tract, vascular endothelium and cholangiocytes of the liver. The effects of COVID-19 on underlying chronic liver disease require detailed evaluation and, with data currently lacking, further research is warranted in this area.
目前由严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）引起的 2019 年冠状病毒病（COVID-19）大流行，在过去几个月已成为重大公共卫生危机。总体病死率在 2%-6%之间；然而，在老年人和患有糖尿病、高血压和心脏病等潜在合并症的人群中，病死率更高。最近的报告显示，约 2%-11%的 COVID-19 患者有潜在的慢性肝脏疾病。在之前的 SARS 流行期间，约 60%的患者被报道出现不同程度的肝损伤。在当前的大流行中，COVID-19 患者中有 14%-53%出现肝功能障碍，尤其是在重症患者中。有报告称发生急性肝损伤病例，且与更高的死亡率相关。COVID-19 中的肝脏受累可能与病毒的直接细胞病变作用、失控的免疫反应、脓毒症或药物性肝损伤有关。病毒进入的假设机制是通过宿主血管紧张素转换酶 2（ACE2）受体，该受体在 2 型肺泡细胞中大量存在。有趣的是，ACE2 受体在胃肠道、血管内皮和肝脏的胆管细胞中表达。COVID-19 对潜在慢性肝脏疾病的影响需要详细评估，由于目前缺乏数据，因此该领域需要进一步研究。
