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[新型冠状病毒肺炎引发自身免疫性肝炎。病例报告]

[COVID-19 as a trigger of autoimmune hepatitis. Case report].

作者信息

Volchkova E A, Legkova K S, Topchy T B

机构信息

City Clinical Hospital №51.

Central State Medical Academy of the President of the Russian Federation.

出版信息

Ter Arkh. 2022 Feb 15;94(2):259-264. doi: 10.26442/00403660.2022.02.201374.

Abstract

Over the past two years, the entire medical community has taken up the fight against the new coronavirus infection. At the initial encounter with COVID-19, it seemed that this virus mainly affects the respiratory system. Still, with long-term observation, it turned out that the consequences of this disease can be much more severe and associated with lung damage and thromboembolic complications, and be a trigger for autoimmune diseases. According to the literature, after suffering COVID-19, some patients debuted systemic lupus erythematosus, hemolytic anemia, thrombocytopenia, developed GuillainBarr syndrome, vasculitis, and multiple sclerosis, and a case of autoimmune hepatitis (AIH) was described in foreign literature. AIH is a fairly rare disease, the prevalence of which in Europe is 1618 cases per 100 thousand inhabitants, affecting mainly women. It is known that chemicals and drugs (minocycline, diclofenac, methyldopa, infliximab, etanercept), viruses (HAV, HEV, EBV, HCV, CMV), environmental factors can serve as triggers of the autoimmune process in the liver. This article presents two clinical cases of AIH that developed after suffering a new coronavirus infection, which we consider as the initial provoking factor of autoimmune inflammation. Given the rarity of AIH, the description of new triggers is of clinical interest. It may be useful for doctors of different specialties since they faced drug-induced liver damage against the background of antiviral and immunobiological therapy. In the domestic literature, there have not yet been any publications devoted to the debut of AIH in adults after coronavirus infection.

摘要

在过去两年里,整个医学界都投入到了抗击新型冠状病毒感染的战斗中。在最初接触新冠病毒时,似乎这种病毒主要影响呼吸系统。然而,经过长期观察发现,这种疾病的后果可能更为严重,与肺损伤和血栓栓塞并发症有关,并且是自身免疫性疾病的诱因。根据文献记载,感染新冠病毒后,一些患者首次出现系统性红斑狼疮、溶血性贫血、血小板减少症,患上格林-巴利综合征、血管炎和多发性硬化症,国外文献还描述了一例自身免疫性肝炎(AIH)。AIH是一种相当罕见的疾病,在欧洲的患病率为每10万人中有16 - 18例,主要影响女性。已知化学物质和药物(米诺环素、双氯芬酸、甲基多巴、英夫利昔单抗、依那西普)、病毒(甲型肝炎病毒、戊型肝炎病毒、EB病毒、丙型肝炎病毒、巨细胞病毒)、环境因素可作为肝脏自身免疫过程的触发因素。本文介绍了两例新型冠状病毒感染后发生的AIH临床病例,我们将新冠病毒感染视为自身免疫性炎症的初始诱发因素。鉴于AIH的罕见性,对新触发因素的描述具有临床意义。这可能对不同专业的医生有用,因为他们在抗病毒和免疫生物治疗背景下面临药物性肝损伤问题。在国内文献中,尚未有关于新冠病毒感染后成人首次出现AIH的相关报道。

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