Патология печени при СOVID‑19 после завершения пандемии: современный взгляд на проблему

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.

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