Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Hepatol Commun. 2022 Sep;6(9):2513-2522. doi: 10.1002/hep4.1979. Epub 2022 May 4.
Immune-mediated liver injury (ILI) following coronavirus disease 2019 (COVID-19) vaccination is not well-characterized. Therefore, we systematically reviewed the literature on ILI after COVID-19 vaccination. We searched PubMed, Cochrane, Ovid, Embase, and gray literature to include articles describing ILI following COVID-19 vaccination. Reports without confirmatory evidence from liver biopsy were excluded. Descriptive analysis, and study quality were reported as appropriate. Of the 1,048 articles found, 13 (good/fair quality; 23 patients) were included. Studies were primarily from Europe (n = 8), America (n = 2), Asia (n = 2), or Australia (n = 1). Patients were predominantly females (62.5%) of age 55.3 years (49.1-61.4), with an antecedent exposure to Moderna messenger RNA (mRNA)-1273 (47.8%), Pfizer-BioNTech BNT162b2 mRNA (39.2%), or ChAdOx1 nCoV-19 vaccine (13%). Pre-existing comorbidities (69.6%) were common, including liver disease in 26.1% and thyroid disorders in 13% of patients. About two-thirds of the patients were on concurrent medications (paracetamol, levothyroxine, statins, and non-steroidal anti-inflammatory drugs). Jaundice was the most common symptom (78.3%). Peak bilirubin, alanine aminotransferase, and alkaline phosphatase levels were 10.8 (6.8-14.8) mg/dl, 1,106.5 (757.0-1,702.5) U/L, and 229 (174.6-259.6) U/L, respectively. Histological findings were intense portal lymphoplasmacytic infiltrate with interface hepatitis. Steroids were used in 86.9% of patients, and complete response, recovering course, and death were reported in 56.5%, 39.1%, and 4.3% of patients, respectively. ILI following COVID-19 vaccination is rare. The diagnosis is established on temporal correlation, biochemical findings, and histopathology. Prognosis is excellent with corticosteroids. Causality establishment remains a challenge.
新型冠状病毒疾病 2019（COVID-19）疫苗接种后的免疫介导性肝损伤（ILI）尚未得到很好的描述。因此，我们系统地回顾了 COVID-19 疫苗接种后 ILI 的文献。我们搜索了 PubMed、Cochrane、Ovid、Embase 和灰色文献，以纳入描述 COVID-19 疫苗接种后 ILI 的文章。没有肝活检确认证据的报告被排除在外。适当报告了描述性分析和研究质量。在发现的 1048 篇文章中，纳入了 13 篇（质量良好/中等；23 名患者）。研究主要来自欧洲（n=8）、美洲（n=2）、亚洲（n=2）或澳大利亚（n=1）。患者主要为女性（62.5%），年龄 55.3 岁（49.1-61.4），先前接触过 Moderna 信使 RNA（mRNA）-1273（47.8%）、辉瑞-BioNTech BNT162b2 mRNA（39.2%）或 ChAdOx1 nCoV-19 疫苗（13%）。常见的合并症（69.6%）包括肝脏疾病（26.1%）和甲状腺疾病（13%）。大约三分之二的患者同时服用药物（对乙酰氨基酚、左甲状腺素、他汀类药物和非甾体抗炎药）。黄疸是最常见的症状（78.3%）。胆红素、丙氨酸氨基转移酶和碱性磷酸酶的峰值水平分别为 10.8（6.8-14.8）mg/dl、1106.5（757.0-1702.5）U/L 和 229（174.6-259.6）U/L。组织学发现为强烈的门脉淋巴浆细胞浸润伴界面肝炎。86.9%的患者使用了类固醇，56.5%、39.1%和 4.3%的患者完全缓解、恢复过程和死亡。COVID-19 疫苗接种后的 ILI 很少见。诊断是基于时间相关性、生化发现和组织病理学。使用皮质类固醇后预后良好。因果关系的建立仍然是一个挑战。
