Centro de Terapia Intensiva do Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
Cirurgia Pediatrica e Transplante Hepatico do Instituto da Crianca e do Adolescente (ICr), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
Clinics (Sao Paulo). 2020 Nov 11;75:e2250. doi: 10.6061/clinics/2020/e2250. eCollection 2020.
SARS-CoV-2 shares nearly 80% of its' genomic sequence with SARS-CoV and MERS-CoV, both viruses known to cause respiratory symptoms and liver impairment. The emergence of pediatric cases of multisystem inflammatory syndrome related to the SARS-CoV-2 infection (PIM-TS) has raised concerns over the issue of hepatic damage and liver enzyme elevation in the critically ill pediatric population with COVID-19. Some retrospective cohorts and case series have shown various degrees of ALT/AST elevation in SARS-CoV-2 infections. A limited number of liver histopathological studies are available that show focal hepatic periportal necrosis. This liver damage was associated with higher levels of inflammatory markers, C-reactive protein (CRP), and pro-calcitonin. Proposed pathophysiological mechanisms include an uncontrolled exacerbated inflammatory response, drug-induced liver injury, direct viral infection and damage to cholangiocytes, hypoxic-ischemic lesions, and micro-thrombosis in the liver. Based on the physiopathological characteristics described, our group proposes a clinical protocol for the surveillance, evaluation, management, and follow-up of critically ill pediatric COVID-19 patients with liver damage.
SARS-CoV-2 与 SARS-CoV 和 MERS-CoV 的基因组序列有近 80%的相似度，这两种病毒都已知会引起呼吸道症状和肝脏损伤。与 SARS-CoV-2 感染相关的儿童多系统炎症综合征（PIM-TS）的出现引起了人们对 COVID-19 危重症患儿肝损伤和肝酶升高的关注。一些回顾性队列和病例系列研究显示，SARS-CoV-2 感染存在不同程度的 ALT/AST 升高。少数肝组织病理学研究显示局灶性肝门脉周围坏死。这种肝损伤与更高水平的炎症标志物、C 反应蛋白（CRP）和降钙素原有关。提出的病理生理机制包括失控的炎症反应加剧、药物性肝损伤、病毒直接感染和胆管细胞损伤、缺氧缺血性病变以及肝脏微血栓形成。基于描述的病理生理特征，我们小组提出了一个用于监测、评估、管理和随访 COVID-19 危重症患儿肝损伤的临床方案。
