SARS-CoV-2 induced liver injury:Incidence,risk factors,impact on COVID-19 severity and prognosis in different population groups  

作　　者：George D Liatsos 

机构地区：[1]Department of Internal Medicine,Hippokration General Hospital,Athens 11527,Attiki,Greece

出　　处：《World Journal of Gastroenterology》2023年第16期2397-2432,共36页世界胃肠病学杂志（英文版）

摘　　要：Liver is unlikely the key organ driving mortality in coronavirus disease 2019(COVID-19)however,liver function tests(LFTs)abnormalities are widely observed mostly in moderate and severe cases.According to this review,the overall prevalence of abnormal LFTs in COVID-19 patients ranges from 2.5%to 96.8%worldwide.The geographical variability in the prevalence of underlying diseases is the determinant for the observed discrepancies between East and West.Multifactorial mechanisms are implicated in COVID-19-induced liver injury.Among them,hypercytokinemia with“bystander hepatitis”,cytokine storm syndrome with subsequent oxidative stress and endotheliopathy,hypercoagulable state and immuno-thromboinflammation are the most determinant mechanisms leading to tissue injury.Liver hypoxia may also contribute under specific conditions,while direct hepatocyte injury is an emerging mechanism.Except for initially observed severe acute respiratory distress syndrome corona virus-2(SARS-CoV-2)tropism for cholangiocytes,more recent cumulative data show SARS-CoV-2 virions within hepatocytes and sinusoidal endothelial cells using electron microscopy(EM).The best evidence for hepatocellular invasion by the virus is the identification of replicating SARS-CoV-2 RNA,S protein RNA and viral nucleocapsid protein within hepatocytes using in-situ hybridization and immunostaining with observed intrahepatic presence of SARS-CoV-2 by EM and by in-situ hybridization.New data mostly derived from imaging findings indicate possible long-term sequelae for the liver months after recovery,suggesting a post-COVID-19 persistent live injury.

关 键 词：COVID-19 SARS-CoV-2 Liver injury Cytokine storm Endotheliopathy Immuno-thromboinflammation Direct hepatocyte injury 

分 类 号：R575[医药卫生—消化系统] R563.1[医药卫生—内科学]