Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.
Department of Surgery and Transplant Institute, NYU Grossman School of Medicine, New York, New York, USA.
Am J Gastroenterol. 2021 Jul 1;116(7):1414-1425. doi: 10.14309/ajg.0000000000001264.
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 virus, is a predominantly respiratory tract infection with the capacity to affect multiple organ systems. Abnormal liver tests, mainly transaminase elevations, have been reported in hospitalized patients. We describe a syndrome of cholangiopathy in patients recovering from severe COVID-19 characterized by marked elevation in serum alkaline phosphatase (ALP) accompanied by evidence of bile duct injury on imaging.
We conducted a retrospective study of COVID-19 patients admitted to our institution from March 1, 2020, to August 15, 2020, on whom the hepatology service was consulted for abnormal liver tests. Bile duct injury was identified by abnormal liver tests with serum ALP > 3x upper limit of normal and abnormal findings on magnetic resonance cholangiopacreatography. Clinical, laboratory, radiological, and histological findings were recorded in a Research Electronic Data Capture database.
Twelve patients were identified, 11 men and 1 woman, with a mean age of 58 years. Mean time from COVID-19 diagnosis to diagnosis of cholangiopathy was 118 days. Peak median serum alanine aminotransferase was 661 U/L and peak median serum ALP was 1855 U/L. Marked elevations of erythrocyte sedimentation rate, C-reactive protein, and D-dimers were common. Magnetic resonance cholangiopacreatography findings included beading of intrahepatic ducts (11/12, 92%), bile duct wall thickening with enhancement (7/12, 58%), and peribiliary diffusion high signal (10/12, 83%). Liver biopsy in 4 patients showed acute and/or chronic large duct obstruction without clear bile duct loss. Progressive biliary tract damage has been demonstrated radiographically. Five patients were referred for consideration of liver transplantation after experiencing persistent jaundice, hepatic insufficiency, and/or recurrent bacterial cholangitis. One patient underwent successful living donor liver transplantation.
Cholangiopathy is a late complication of severe COVID-19 with the potential for progressive biliary injury and liver failure. Further studies are required to understand pathogenesis, natural history, and therapeutic interventions.
由严重急性呼吸系统综合征冠状病毒 2 型病毒引起的 2019 年冠状病毒病（COVID-19）主要是呼吸道感染，有能力影响多个器官系统。在住院患者中，已报告肝功能检查异常，主要为转氨酶升高。我们描述了一种在从严重 COVID-19 中康复的患者中出现的胆管病综合征，其特征是血清碱性磷酸酶（ALP）显著升高，同时影像学检查显示胆管损伤的证据。
我们对 2020 年 3 月 1 日至 2020 年 8 月 15 日期间因异常肝功能检查而向我们的肝病科咨询的 COVID-19 住院患者进行了回顾性研究。胆管损伤通过异常的肝功能检查（血清 ALP > 3 倍正常值上限）和磁共振胰胆管造影术的异常发现来确定。临床、实验室、影像学和组织学发现均记录在 Research Electronic Data Capture 数据库中。
共确定了 12 名患者，其中 11 名男性和 1 名女性，平均年龄为 58 岁。从 COVID-19 诊断到胆管病诊断的平均时间为 118 天。中位血清丙氨酸氨基转移酶峰值为 661 U/L，中位血清 ALP 峰值为 1855 U/L。红细胞沉降率、C 反应蛋白和 D-二聚体的显著升高很常见。磁共振胰胆管造影术的发现包括肝内胆管呈珠状（12/12，92%）、胆管壁增厚伴强化（7/12，58%）和周边胆管扩散高信号（10/12，83%）。4 名患者的肝活检显示急性和/或慢性大胆管阻塞，没有明确的胆管丢失。影像学显示进行性胆道损伤。5 名患者因持续性黄疸、肝功能不全和/或复发性细菌性胆管炎而接受肝移植治疗。1 名患者成功接受活体供肝移植。
胆管病是严重 COVID-19 的一种晚期并发症，有进行性胆管损伤和肝功能衰竭的潜在风险。需要进一步研究以了解发病机制、自然史和治疗干预措施。
