Center for Health Research, Guangdong Provincial Key Laboratory of Biocomputing, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China; University of Chinese Academy of Sciences, Beijing, China; Key Laboratory of Stem Cell and Regenerative Medicine, CAS Key Laboratory of Regenerative Biology, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China.
Center for Health Research, Guangdong Provincial Key Laboratory of Biocomputing, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China; University of Chinese Academy of Sciences, Beijing, China; Key Laboratory of Stem Cell and Regenerative Medicine, CAS Key Laboratory of Regenerative Biology, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China; State Key Laboratory of Respiratory Disease, Guangzhou, China; China-New Zealand Joint Laboratory on Biomedicine and Health, Guangzhou, China.
Biomed Pharmacother. 2022 Oct;154:113568. doi: 10.1016/j.biopha.2022.113568. Epub 2022 Aug 17.
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has become a global epidemic and poses a major threat to public health. In addition to COVID-19 manifesting as a respiratory disease, patients with severe disease also have complications in extrapulmonary organs, including liver damage. Abnormal liver function is relatively common in COVID-19 patients; its clinical manifestations can range from an asymptomatic elevation of liver enzymes to decompensated hepatic function, and liver injury is more prevalent in severe and critical patients. Liver injury in COVID-19 patients is a comprehensive effect mediated by multiple factors, including liver damage directly caused by SARS-CoV-2, drug-induced liver damage, hypoxia reperfusion dysfunction, immune stress and inflammatory factor storms. Patients with chronic liver disease (especially alcohol-related liver disease, nonalcoholic fatty liver disease, cirrhosis and hepatocellular carcinoma) are at increased risk of severe disease and death after infection with SARS-CoV-2, and COVID-19 aggravates liver damage in patients with chronic liver disease. This article reviews the latest SARS-CoV-2 reports, focusing on the liver damage caused by COVID-19 and the underlying mechanism, and expounds on the risk, treatment and vaccine safety of SARS-CoV-2 in patients with chronic liver disease and liver transplantation.
新型冠状病毒病(COVID-19),由严重急性呼吸综合征冠状病毒-2(SARS-CoV-2)引起,已成为全球性流行病,对公共卫生构成重大威胁。除 COVID-19 表现为呼吸道疾病外,重症患者还存在肺外器官并发症,包括肝损伤。COVID-19 患者的肝功能异常较为常见;其临床表现可从无症状的肝酶升高到肝功能失代偿,且严重和危重症患者中肝损伤更为普遍。COVID-19 患者的肝损伤是多种因素介导的综合效应,包括 SARS-CoV-2 直接引起的肝损伤、药物性肝损伤、缺氧再灌注功能障碍、免疫应激和炎症因子风暴。慢性肝病(尤其是酒精性肝病、非酒精性脂肪性肝病、肝硬化和肝细胞癌)患者感染 SARS-CoV-2 后发生重症和死亡的风险增加,COVID-19 会加重慢性肝病患者的肝损伤。本文复习了最新的 SARS-CoV-2 报告,重点关注 COVID-19 引起的肝损伤及其潜在机制,并阐述了慢性肝病和肝移植患者 SARS-CoV-2 的风险、治疗和疫苗安全性。
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