medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2023-34-10-15medalphabet-3472Research ArticleСтатьиПатология печени при СOVID‑19 после завершения пандемии: современный взгляд на проблемуLiver pathology in COVID-19 after end of pandemic: Modern view of problemhttps://orcid.org/0000-0001-6725-8290ЛевитанБ. Н.LevitanB. N.

Левитан Болеслав Наумович, д.м.н., проф., зав. кафедрой факультетской терапии и профессиональных болезней с курсом последипломного образования,

г. Астрахань

Scopus: 7003706105. 

Levitan Boleslav N., DM Sci (habil.), head of Dept of Faculty Therapy and Occupational Diseases with a course of postgraduate education,

Astrakhan.

Scopus ID: 7003706105.

bolev@mail.ruhttps://orcid.org/0000-0003-0842-0336СердюковаТ. В.SerdyukovaT. V.

Сердюкова Татьяна Васильевна, к.м.н., доцент кафедры факультетской терапии и профессиональных болезней с курсом последипломного образования,

г. Астрахань.

Serdyukova Tatyana V., PhD Med, associate professor at Dept of Faculty Therapy and Occupational Diseases with a course of postgraduate education,

Astrakhan.

85tatyanka@mail.ruhttps://orcid.org/0000-0002-2164-3537СкворцовВ. В.SkvortsovV. V.

Скворцов Всеволод Владимирович, д.м.н., профессор кафедры пропедевтики внутренних болезней,

г. Волгоград.

Skvortsov Vsevolod V., DM Sci (habil.), professor at Dept of Internal Diseases,

Volgograd.

vskvortsov1@ya.ruФГБОУ ВО «Астраханский государственный медицинский университет» Минздрава РоссииРоссияAstrakhan State Medical UniversityRussian FederationФГБОУ ВО «Волгоградский государственный медицинский университет» Минздрава РоссииРоссияVolgograd State Medical UniversityRussian Federation202317012024034Обозрение (3)1015Copyright © Левитан Б.Н., Сердюкова Т.В., Скворцов В.В., 20242024Левитан Б.Н., Сердюкова Т.В., Скворцов В.В.Levitan B.N., Serdyukova T.V., Skvortsov V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/3472

Пандемия COVID‑19, о которой впервые сообщалось в конце 2019 года, несмотря на завершение в мае 2023-го, продолжает оказывать разрушительное воздействие на глобальное здравоохранение в связи со значительными связанными с ней показателями заболеваемости и смертности. Повреждение печени является распространенным признаком у пациентов с COVID‑19 и варьирует от легкого и временного повышения уровня печеночных ферментов до тяжелого поражения печени и даже острой печеночной недостаточности. Целью настоящего обзора является представление данных о распространенности, патофизиологических механизмах, возможностях лечения поражения печени у пациентов с инфекцией SARS-CoV‑2. За повреждение печени при COVID‑19 ответственны несколько патофизиологических механизмов, включая прямое цитотоксическое действие вируса, цитокиновый шторм, гипоксию и ишемию органа, лекарственную гепатотоксичность. Пациенты с фоновым хроническим заболеванием печени (ХЗП) –циррозом печени, неалкогольной жировой болезнью печени, алкогольной болезнью печени, гепатоцеллюлярной карциномой и т.д.–могут иметь повышенный риск развития как тяжелого COVID‑19, так и дальнейшего ухудшения состояния печени. У части больных COVID‑19 возникают явления постковидного синдрома, известного также как постострый COVID‑19, длительный COVID‑19 или long COVID‑19. К наиболее распространенным проявлениям постковидного синдрома у больных с патологией печени, как развившейся непосредственно в связи с инфекцией SARS-Cov‑2, так и у лиц с имевшимися ранее ХЗП, относятся явления астеновегетативного синдрома, а также клинико-биохимические признаки умеренно выраженных синдромов цитолиза и холестаза.

The COVID‑19 pandemic, first reported in late 2019, despite ending in May 2023, continues to have a devastating impact on global health with significant associated morbidity and mortality rates. Liver injury is a common feature in patients with COVID‑19 and ranges from mild and temporary elevation of liver enzymes to severe liver damage and even acute liver failure. The purpose of this review is to present data on the prevalence, pathophysiological mechanisms, clinical manifestations, diagnosis, course features, complications, and treatment options for liver damage in patients with SARS-CoV‑2. Several pathophysiological mechanisms are responsible for liver damage in COVID‑19, including the direct cytotoxic effect of the virus, cytokine storm, hypoxia and ischemia of the organ, and drug hepatotoxicity. Patients with underlying chronic liver disease (CLD) (liver cirrhosis, non-alcoholic fatty liver disease, alcohol-related liver disease, hepatocellular carcinoma, etc.) may have greater risk to develop both severe COVID‑19 and further liver deterioration. Some COVID‑19 patients experience post-covid syndrome, also known as post-acute COVID‑19, long-term COVID‑19 or long COVID‑19. The most common manifestations of post-covid syndrome in patients with liver pathology, both developed directly in connection with SARS-Cov‑2 infection, and in people with pre-existing CLD, include the phenomena of astheno-vegetative syndrome, as well as clinical and biochemical signs of moderate cytolysis and cholestasis syndrome.

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The authors declare that there are no conflicts of interest present.