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COVID-19 相关肝损伤:临床特征、病理生理机制和治疗管理。

COVID-19-associated liver injury: Clinical characteristics, pathophysiological mechanisms and treatment management.

机构信息

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.

出版信息

Biomed Pharmacother. 2022 Oct;154:113568. doi: 10.1016/j.biopha.2022.113568. Epub 2022 Aug 17.


DOI:10.1016/j.biopha.2022.113568
PMID:36029543
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9381432/
Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8cf/9381432/491fef948aa9/gr4_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8cf/9381432/95bc53197163/ga1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8cf/9381432/0052e6aeae0b/gr1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8cf/9381432/a4d504184714/gr2_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8cf/9381432/d7af612cd6ba/gr3_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8cf/9381432/491fef948aa9/gr4_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8cf/9381432/95bc53197163/ga1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8cf/9381432/0052e6aeae0b/gr1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8cf/9381432/a4d504184714/gr2_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8cf/9381432/d7af612cd6ba/gr3_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8cf/9381432/491fef948aa9/gr4_lrg.jpg

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本文引用的文献

[1]
Increased mortality of patients with alcohol-related liver diseases during the COVID-19 pandemic in the United States.

J Intern Med. 2022-11

[2]
Impact of COVID-19 on the liver and on the care of patients with chronic liver disease, hepatobiliary cancer, and liver transplantation: An updated EASL position paper.

J Hepatol. 2022-10

[3]
Humoral and Cellular Immune Response After Third and Fourth SARS-CoV-2 mRNA Vaccination in Liver Transplant Recipients.

Clin Gastroenterol Hepatol. 2022-11

[4]
Incidence and severity of SARS-CoV-2 infections in liver and kidney transplant recipients in the post-vaccination era: Real-life data from Denmark.

Am J Transplant. 2022-11

[5]
SARS-CoV-2 infection impairs the insulin/IGF signaling pathway in the lung, liver, adipose tissue, and pancreatic cells via IRF1.

Metabolism. 2022-8

[6]
Outcome of liver cancer patients with SARS-CoV-2 infection: An International, Multicentre, Cohort Study.

Liver Int. 2022-8

[7]
Long-term ketamine infusion-induced cholestatic liver injury in COVID-19-associated acute respiratory distress syndrome.

Crit Care. 2022-5-23

[8]
Progressive cholestasis and associated sclerosing cholangitis are frequent complications of COVID-19 in patients with chronic liver disease.

Hepatology. 2022-12

[9]
Liver Fibrosis Scores and Clinical Outcomes in Patients With COVID-19.

Front Med (Lausanne). 2022-4-8

[10]
A third dose of the BNT162b2 mRNA vaccine significantly improves immune responses among liver transplant recipients.

J Hepatol. 2022-9

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