Department of Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, Haryana, India.
World J Gastroenterol. 2023 Jan 28;29(4):656-669. doi: 10.3748/wjg.v29.i4.656.
The coronavirus disease 2019 (COVID-19) hit the entire world as a global pandemic and soon became the most important concern for all patients with chronic diseases. An early trend in higher mortality in patients with acute respiratory distress attracted all researchers to closely monitor patients for the involvement of other systems. It soon became apparent that patients with chronic liver diseases are at increased risk of mortality given their cirrhosis-associated immune dysfunction. Additionally, liver function abnormalities were noted in patients with severe COVID-19. Profound cytokine storm, direct viral infection, drugs and reactivation of viral infections were causes of deranged liver functions. Here, we discuss the relation between COVID-19 and chronic liver disease, specifically cirrhosis, hepatitis B, hepatitis C, and non-alcoholic fatty liver disease (NAFLD), as well as the liver manifestations of COVID-19. The metabolic syndrome, obesity, diabetes mellitus and NAFLD were found to worsen outcome in different studies reported worldwide. Decompensated cirrhosis should be considered a risk factor for death and severe COVID-19. Recently, COVID-19 related cholangiopathy has also been reported with changes of secondary sclerosing cholangitis. The long-term persistence of viral antigens in gut epithelia raises concern regarding the future risk of autoimmune liver diseases.
2019 年冠状病毒病（COVID-19）在全球大流行，成为所有慢性病患者最关注的问题。急性呼吸窘迫患者死亡率较高的早期趋势引起了所有研究人员的密切关注，以监测其他系统的受累情况。很快就发现，慢性肝脏疾病患者由于与肝硬化相关的免疫功能障碍而面临更高的死亡风险。此外，严重 COVID-19 患者的肝功能也出现异常。细胞因子风暴、直接病毒感染、药物和病毒再激活是肝功能紊乱的原因。在这里，我们讨论了 COVID-19 与慢性肝病（特别是肝硬化、乙型肝炎、丙型肝炎和非酒精性脂肪性肝病（NAFLD））之间的关系，以及 COVID-19 的肝脏表现。在全球范围内报道的不同研究中发现，代谢综合征、肥胖、糖尿病和非酒精性脂肪性肝病使病情恶化。失代偿性肝硬化应被视为死亡和严重 COVID-19 的危险因素。最近，也有报道称 COVID-19 相关胆管病伴有继发性硬化性胆管炎的变化。肠道上皮中病毒抗原的长期存在引起了对自身免疫性肝病未来风险的关注。
