Механизмы повреждения печени при COVID-19

Мнацаканян М.Г., Погромов А.П., Лишута А.С., Фомин В.В., Волкова О.С., Тащян О.В., Куприна И.В., Шумская Ю.Ф. Механизмы повреждения печени при COVID-19. Терапевтический архив. 2021; 93 (4): 427–430.
DOI: 10.26442/00403660.2021.04.200733

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Mnatsakanyan MG, Pogromov AP, Lishuta AS, Fomin VV, Volkova OS, Tashchyan OV, Kuprina IV, Shumskaya YuF. Liver and COVID-19: possible mechanisms of damage. Terapevticheskii Arkhiv (Ter. Arkh). 2021; 93 (4): 427–430. DOI: 10.26442/00403660.2021.04.200733

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Аннотация

Глобальная эпидемия новой коронавирусной инфекции, вызванной SARS-CoV-2, представляет большую угрозу для здоровья человечества. В клинической картине наряду с острым респираторным дистресс-синдромом отмечаются также поражения печени. В настоящее время рассматриваются следующие механизмы: прямое повреждающее действие SARS-CoV-2, иммуноопосредованное воспаление, гипоксия, воздействие лекарственных препаратов и реактивация ранее существовавшего заболевания печени. Исследованы 150 больных с COVID-пневмонией, находящихся на стационарном лечении в Университетской клинической больнице №1 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России. Из них наличие РНК SARS-CoV-2 методом полимеразной цепной реакции подтверждено у 84 (56,0%) пациентов. У 55 (36,7%) больных зарегистрировано повышение сывороточных аминотрансфераз, преимущественно аланинаминотрансферазы максимально до 572 ед/л и аспартатаминотрансферазы максимально до 232 ед/л. Отдаленные последствия неизвестны и требуют мониторинга этих больных.

Ключевые слова: SARS-CoV-2, печень, поражения печени

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The global epidemic of a new coronavirus infection caused by SARS-CoV-2 is a major threat to human health. In the clinical picture, along with acute respiratory distress syndrome, liver lesions are also noted. The following mechanisms are currently being considered: direct damaging effects of SARS-CoV-2, immuno-mediated inflammation, hypoxia, drug exposure, and reactivation of pre-existing liver disease. We studied 150 patients with COVID-pneumonia who are under inpatient treatment at the University Clinical Hospital No. 1 of Sechenov First Moscow State Medical University. Of these, the presence of SARS-CoV-2 RNA was confirmed by polymerase chain reaction in 84 (56.0%) patients. In 55 (36.7%) patients, an increase in serum aminotransferases was registered, mainly alanine aminotransferase max. up to 572 U/L and aspartate aminotransferase up to a max. of 232 U/L. The long-term consequences are unknown and require monitoring of these patients.

Keywords: SARS-CoV-2, liver, liver damage

Список литературы

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1. Pan L, Mu M, Ren HG, on behalf of the Wuhan Medical Treatment Expert Group for COVID-19 Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol. 2020. doi: 10.14309/ajg.0000000000000620
2. Guan W, Ni Z, Hu Y. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020. doi: 10.1056/NEJMoa2002032
3. Wang D, Hu B, Hu C. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus – infected pneumonia in Wuhan, China. JAMA. 2020. doi: 10.1001/jama.2020.1585
4. Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: is faecal–oral transmission of SARS-CoV-2 possible? Lancet Gastroenterol Hepatol. 2020. doi: 10.1016/S2468-1253(20)30048-0
5. Feng G, Zheng KI, Yan Q-Q, et al. COVID-19 and Liver dysfunction: current insights and emergent therapeutic strategies. J Clin Transl Hepatol. 2020;8:18-24.
6. Garrido I, Liberal R, Macedo G. Review article: COVID-19 and liver disease-what we know on 1st May 2020 [published online ahead of print, 2020 May 13]. Aliment Pharmacol Ther. 2020. doi: 10.1111/apt.15813
7. Mao R, Qiu Y, He Jin-Shen, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020. doi: 10.1016/S2468-1253(20)30126-6
8. Chai X, Hu L, Zhang Y. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. bioRxiv. 2020. Published online Feb 4. (preprint). doi: 10.1101/2020.02.03.931766
9. Sun J, Aghemo A, Forner A, Valenti L. COVID-19 and liver disease. Liver International. 2020;40:1278-81.
10. Zhang C, Shi L, Wang F-S. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 2020;5(5):428-30.
11. Fries JF, Singh G, Lenert L, Furst DE. Aspirin, hydroxychloroquine, and hepatic enzyme abnormalities with methotrexate in rheumatoid arthritis. Arthritis Rheum.1990;33:1611-9.
12. Sulkowski MS. Drug-induced liver injury associated with antiretroviral therapy that includes HIV-1 protease inhibitors. Clin Infect Dis. 2004;38:S90-S97.
13. Casado JL, Del Palacio M, Moya J, et al. Safety and pharmacokinetics of lopinavir in HIV/HCV coinfected patients with advanced liver disease. HIV Clin Trials. 2011;12:235-43.
14. Liu C, Jiang ZC, Shao CX, et al. Preliminary Study of the Relationship Between Novel Coronavirus Pneumonia and Liver Function Damage: A Multicenter Study. Zhonghua Gan Zang Bing Za Zhi. 2020;28(2):107-11. doi: 10.3760/cma.j.issn.1007-3418.2020.02.003
15. Boettler T, Newsome PN, Mondelli MU, et al. Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper. JHEP Rep. 2020;2(3):100113.
16. Schütte A, Ciesek S, Wedemeyer H, Lange CM. Influenza virus infection as precipitating event of acute-on-chronic liver failure. J Hepatol. 2019;70:797-9.
17. Xiao Y, Pan H, She Q, et al. Prevention of SARS-CoV-2 infection in patients with decompensated cirrhosis. Lancet Gastroenterol Hepatol. 2020;5:528-9.
18. Zairatyants OV, Samsonova MV, Mihaleva LM, et al. Pathological anatomy of the COVID-19. Atlas. Moscow: Departament zdravookhraneniia g. Moskvy, 2020 (In Russ.)
19. Xu Z, Shi L, Wang Y. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020. Published online Feb 18. doi: 10.1016/S2213-2600(20)30076-X
20. Zhang Y, Zheng L, Liu L, et al. Liver impairment in COVID-19 patients: a retrospective analysis of 115 cases from a single center in Wuhan city, China. Liver Int. 2020. doi: 10.1111/liv.14455

Авторы

М.Г. Мнацаканян*, А.П. Погромов, А.С. Лишута, В.В. Фомин, О.С. Волкова, О.В. Тащян, И.В. Куприна, Ю.Ф. Шумская

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*mnatsakanyanmg@gmail.com

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Marina G. Mnatsakanyan*, Aleksandr P. Pogromov, Aleksei S. Lishuta, Victor V. Fomin, Olga S. Volkova, Olga V. Tashchyan, Irina V. Kuprina, Yuliia F. Shumskaya

Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*mnatsakanyanmg@gmail.com

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