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严重急性呼吸综合征冠状病毒2的嗜肝特性——来自第一波新冠疫情大流行的横断面观察研究初步结果

Hepatotropic Properties of SARS-CoV-2-Preliminary Results of Cross-Sectional Observational Study from the First Wave COVID-19 Pandemic.

作者信息

Wiśniewska Hanna, Skonieczna-Żydecka Karolina, Parczewski Miłosz, Niścigorska-Olsen Jolanta, Karpińska Ewa, Hornung Monika, Jurczyk Krzysztof, Witak-Jędra Magdalena, Laurans Łukasz, Maciejewska Katarzyna, Socha Łukasz, Leonciuk Agnieszka, Bander Dorota, Karasińska-Cieślak Malwina, Aksak-Wąs Bogusz, Wawrzynowicz-Syczewska Marta

机构信息

Department of Infectious Diseases, Hepatology and Liver Transplantation, Pomeranian Medical University, 71-455 Szczecin, Poland.

Department of Biochemical Sciences, Pomeranian Medical University, 71-460 Szczecin, Poland.

出版信息

J Clin Med. 2021 Feb 9;10(4):672. doi: 10.3390/jcm10040672.

Abstract

Liver injury-expressed as elevated liver enzymes-is common in patients with COVID-19. Little is known about the potential mechanisms of liver damage by SARS-CoV-2. A direct cytopathic effect on hepatocytes as well as injury related to hypoxia or hepatotoxicity are being considered. The aim of the study was to compare the clinical characteristic of COVID-19 disease in patients with normal and abnormal liver enzymes activity. A group of 150 patients with COVID-19, hospitalized in our center, was analyzed. Patients with the known liver comorbidities were excluded ( = 15). Clinical features and laboratory parameters were compared between patients with normal and abnormal aminotransferase values. Liver injury expressed as any alanine aminotransferase (ALT) elevation was noted in 45.6% of patients hospitalized due to COVID-19. The frequencies of aspartate aminotransferase (AST) elevation were lower. It was noted that elevated ALT/AST unfavorably affected other parameters related to liver function such as albumin level; gamma-glutamyl transpeptidase (GGTP); and partly, ALP activity and influenced inflammation-related parameters. The most probable cause of mild hepatitis during COVID-19 was anoxia and immune-mediated damage due to the inflammatory response following SARS-CoV-2 infection. A direct cytopathic effect of SARS-CoV-2 on hepatocytes, albeit less probable, can be considered as well. The use of potentially hepatotoxic drugs may contribute to liver damage.

摘要

肝损伤(表现为肝酶升高)在新冠肺炎患者中很常见。关于严重急性呼吸综合征冠状病毒2(SARS-CoV-2)导致肝损伤的潜在机制,人们了解甚少。目前正在考虑其对肝细胞的直接细胞病变效应以及与缺氧或肝毒性相关的损伤。本研究的目的是比较肝酶活性正常和异常的新冠肺炎患者的临床特征。对在我们中心住院的150例新冠肺炎患者进行了分析。排除已知有肝脏合并症的患者(n = 15)。比较了转氨酶值正常和异常的患者的临床特征和实验室参数。在因新冠肺炎住院的患者中,45.6%的患者出现了以任何丙氨酸转氨酶(ALT)升高表示的肝损伤。天冬氨酸转氨酶(AST)升高的频率较低。值得注意的是,ALT/AST升高对其他肝功能相关参数产生了不利影响,如白蛋白水平、γ-谷氨酰转肽酶(GGTP),部分还有碱性磷酸酶(ALP)活性,并影响了炎症相关参数。新冠肺炎期间轻度肝炎最可能的原因是缺氧以及SARS-CoV-2感染后炎症反应引起的免疫介导损伤。SARS-CoV-2对肝细胞的直接细胞病变效应虽然可能性较小,但也可以考虑。使用潜在的肝毒性药物可能会导致肝损伤。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bc9/7916209/819e130db90a/jcm-10-00672-g001.jpg

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