Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Colmbus, Ohio.
Curr Opin Gastroenterol. 2022 May 1;38(3):191-199. doi: 10.1097/MOG.0000000000000826. Epub 2022 Mar 11.
The objective of this review is to examine the epidemiology and pathogenesis of liver injury in coronavirus disease 2019 (COVID-19) and the impact of COVID-19 on patients with chronic liver disease (CLD) and liver transplant recipients.
Abnormal liver chemistries occur in up to 60% of COVID-19 patients and are typically mild. COVID-19- associated liver injury may be because of direct viral cytopathic effect, immune-mediated damage, hypoxia, drug-induced liver injury (DILI), or exacerbation of CLD. COVID-19 patients with CLD and who are liver transplant recipients are at risk for severe disease and mortality. COVID-19 precipitated hepatic decompensation in 20-46% of cirrhotic patients. Alcohol consumption and cases of acute alcohol- associated hepatitis increased during the COVID-19 pandemic. Corticosteroids and calcineurin inhibitors are well tolerated to use during COVID-19 but immunomodulators have been associated with mortality. Less than 50% of transplant recipients produce adequate antibody titers after COVID-19 vaccination.
COVID-19 patients with CLD should be monitored for liver injury and hepatic decompensation. Patients with CLD and liver transplant recipients should be considered for targeted COVID-19 pharmacotherapeutics and advised vaccination against COVID-19, including a third booster dose. CLD treatments and immunosuppression in liver transplant recipients could generally continue without interruption during COVID-19 infection, with the possible exception of immunomodulators.
本文旨在探讨 2019 年冠状病毒病（COVID-19）患者肝损伤的流行病学和发病机制，以及 COVID-19 对慢性肝病（CLD）患者和肝移植受者的影响。
高达 60%的 COVID-19 患者出现异常肝功能检查结果，且通常为轻度肝损伤。COVID-19 相关肝损伤可能是由于直接的病毒细胞病变作用、免疫介导的损伤、缺氧、药物性肝损伤（DILI）或 CLD 恶化所致。患有 CLD 且接受肝移植的 COVID-19 患者有发生重症疾病和死亡的风险。COVID-19 可使 20%-46%的肝硬化患者发生肝性失代偿。在 COVID-19 大流行期间，酒精消耗和急性酒精性肝炎病例增加。COVID-19 期间，皮质类固醇和钙调神经磷酸酶抑制剂的使用耐受良好，但免疫调节剂与死亡率相关。COVID-19 疫苗接种后，不到 50%的移植受者产生足够的抗体滴度。
应监测患有 CLD 的 COVID-19 患者的肝损伤和肝性失代偿情况。患有 CLD 和肝移植受者应考虑使用针对 COVID-19 的靶向药物治疗，并建议接种 COVID-19 疫苗，包括第三剂加强针。在 COVID-19 感染期间，一般可继续进行 CLD 治疗和肝移植受者的免疫抑制治疗，可能需要除外免疫调节剂。
