COVID-19 与肝病。

COVID-19 and liver disease.

机构信息

Hepatology, Department of Biomedical Research, University of Bern, Bern, Switzerland

Oxford Liver Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.

出版信息

Gut. 2022 Nov;71(11):2350-2362. doi: 10.1136/gutjnl-2021-326792. Epub 2022 Jun 14.

Abstract

Knowledge on SARS-CoV-2 infection and its resultant COVID-19 in liver diseases has rapidly increased during the pandemic. Hereby, we review COVID-19 liver manifestations and pathophysiological aspects related to SARS-CoV-2 infection in patients without liver disease as well as the impact of COVID-19 in patients with chronic liver disease (CLD), particularly cirrhosis and liver transplantation (LT). SARS-CoV-2 infection has been associated with overt proinflammatory cytokine profile, which probably contributes substantially to the observed early and late liver abnormalities. CLD, particularly decompensated cirrhosis, should be regarded as a risk factor for severe COVID-19 and death. LT was impacted during the pandemic, mainly due to concerns regarding donation and infection in recipients. However, LT did not represent a risk factor per se of worse outcome. Even though scarce, data regarding COVID-19 specific therapy in special populations such as LT recipients seem promising. COVID-19 vaccine-induced immunity seems impaired in CLD and LT recipients, advocating for a revised schedule of vaccine administration in this population.

摘要

在疫情期间,人们对 SARS-CoV-2 感染及其导致的 COVID-19 的认识迅速增加。在此,我们回顾了无肝病患者中与 SARS-CoV-2 感染相关的 COVID-19 肝脏表现和病理生理方面,以及 COVID-19 对慢性肝病(CLD)患者的影响,特别是肝硬化和肝移植(LT)患者。SARS-CoV-2 感染与明显的促炎细胞因子谱有关,这可能是导致早期和晚期肝异常的主要原因。CLD,特别是失代偿性肝硬化,应被视为 COVID-19 重症和死亡的危险因素。疫情期间 LT 受到了影响,主要是因为对供体和受者感染的担忧。然而,LT 本身并不是预后更差的危险因素。尽管数据很少,但关于 LT 受者等特殊人群 COVID-19 特定治疗的的数据似乎很有希望。COVID-19 疫苗诱导的免疫在 CLD 和 LT 受者中似乎受到损害,因此主张在该人群中修订疫苗接种计划。

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