Department of Gastroenterology, Institute of Liver and Gastrointestinal Diseases, Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China.
Department of Gastroenterology, Henan Provincial People's Hospital, Zhengzhou, 450000, Henan Province, China.
J Gastroenterol. 2021 Mar;56(3):218-230. doi: 10.1007/s00535-021-01760-9. Epub 2021 Feb 1.
The outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been a global challenge since December 2019. Although most patients with COVID-19 exhibit mild clinical manifestations, in approximately 5% of these patients, the disease eventually progresses to severe lung injury or even multiorgan dysfunction. This situation represents various challenges to hepatology. In the context of liver injury in patients with COVID-19, several key problems need to be solved. For instance, it is important to determine whether SARS-CoV-2 can directly invade liver, especially when ACE2 appears to be negligibly expressed on hepatocytes. In addition, the mechanisms underlying liver dysfunction in COVID-19 patients are not fully understood, which are likely multifactorial and related to hyperinflammation, dysregulated immune responses, abnormal coagulation and drugs. Here, we systematically describe the potential pathogenesis of COVID-19-associated liver injury and propose several hypotheses about its etiopathogenesis.
2019 年冠状病毒病（COVID-19）的爆发是由严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）引起的，自 2019 年 12 月以来一直是一个全球性挑战。尽管大多数 COVID-19 患者表现为轻度临床症状，但在这些患者中约有 5%的患者，疾病最终会发展为严重的肺部损伤甚至多器官功能障碍。这种情况给肝病学带来了各种挑战。在 COVID-19 患者的肝损伤背景下，需要解决几个关键问题。例如，重要的是要确定 SARS-CoV-2 是否可以直接侵犯肝脏，特别是当 ACE2 似乎在肝细胞上表达可忽略不计时。此外，COVID-19 患者肝功能障碍的机制尚不完全清楚，可能是多因素的，与过度炎症、免疫反应失调、异常凝血和药物有关。在这里，我们系统地描述了 COVID-19 相关肝损伤的潜在发病机制，并提出了关于其发病机制的几个假设。
