Stasi Cristina
Department of Life Science, Health and Health Professions, Link Campus University, 00165 Roma, Italy.
Epidemiology Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy.
Life (Basel). 2025 Mar 4;15(3):403. doi: 10.3390/life15030403.
During the coronavirus disease 2019 (COVID-19) pandemic, several studies highlighted a worse prognosis for patients with alterations in liver function tests, especially those with pre-existing liver diseases. However, further studies are needed to define the long-term impact of the COVID-19 pandemic on liver diseases. Long COVID-19 encompasses a wide range of signs and symptoms, including exacerbations of pre-existing chronic conditions or new onset conditions developed after the COVID-19 acute phase. Therefore, the long-term effects of COVID-19 extensively include hepatic manifestations. The co-expression of angiotensin-converting receptor 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) has been demonstrated also in enterocytes, cholangiocytes, and hepatocytes. Studies on the post-COVID-19 sequelae have shown the presence of steatosis and necroinflammation in the liver, concomitantly with an alteration of inflammation, cytolysis and cholestasis indices. Some studies also demonstrated an increased risk for hepatobiliary pathologies, including secondary biliary cholangitis and worsening of the severity of metabolic-associated fatty liver disease (MASLD). Based on these premises, this review aims to provide an overview of the pathophysiological mechanisms contributing to COVID-19-related liver and hepatobiliary damage; explore its implications for liver inflammation and fibrosis, with a particular focus on MASLD and metabolic dysfunction-associated steatohepatitis (MASH); and analyze the short- and long-term COVID-19 sequelae. A literature search was conducted using the PubMed database for relevant studies published in English.
在2019年冠状病毒病（COVID-19）大流行期间，多项研究强调肝功能检查异常的患者预后较差，尤其是那些患有既往肝病的患者。然而，需要进一步研究来确定COVID-19大流行对肝脏疾病的长期影响。长期COVID-19包括广泛的体征和症状，包括既往慢性病的加重或COVID-19急性期后出现的新发疾病。因此，COVID-19的长期影响广泛包括肝脏表现。血管紧张素转换受体2（ACE2）和跨膜丝氨酸蛋白酶2（TMPRSS2）的共表达也已在肠上皮细胞、胆管细胞和肝细胞中得到证实。关于COVID-19后遗症的研究表明，肝脏存在脂肪变性和坏死性炎症，同时炎症、细胞溶解和胆汁淤积指标发生改变。一些研究还表明，肝胆疾病的风险增加，包括继发性胆汁性胆管炎和代谢相关脂肪性肝病（MASLD）严重程度的恶化。基于这些前提，本综述旨在概述导致COVID-19相关肝脏和肝胆损害的病理生理机制；探讨其对肝脏炎症和纤维化的影响，特别关注MASLD和代谢功能障碍相关脂肪性肝炎（MASH）；并分析COVID-19的短期和长期后遗症。使用PubMed数据库进行文献检索，以查找用英文发表的相关研究。
