avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2020-10-3-188-197avk-1055Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESCOVID-19 и поражение печениCOVID-19 and Liver Damagehttps://orcid.org/0000-0001-6029-1864ИльченкоЛ. Ю.IlchenkoL. Yu.

Людмила Юрьевна Ильченко - кафедра госпитальной терапии № 2 РНИМУ  им.Н.И. Пирогова.

Москва

Lyudmila Yu. Ilchenko - Department of Internal Medicine No. 2 Pirogov RNRMU.

Moscow

ilchenko-med@yandex.ruhttps://orcid.org/0000-0003-1699-0881НикитинИ. Г.NikitinI. G.

Кафедра госпитальной терапии № 2 РНИМУ  им.Н.И. Пирогова

Москва

Department of Internal Medicine No. 2 Pirogov RNRMU.

Moscow

https://orcid.org/0000-0003-1003-539XФедоровИ. Г.FedorovI. G.

Кафедра госпитальной терапии № 2 РНИМУ  им.Н.И. Пирогова

Москва

Department of Internal Medicine No. 2 Pirogov RNRMU.

Moscow

Федеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России; Федеральное государственное бюджетное научное «Федеральный научный центр исследований и разработки иммунобиологических препаратов имени М.П. Чумакова» РАНРоссияFederal State Autonomous Institution of Higher Education «Pirogov Russian National Research Medical University» of the Russian Ministry of Health; Federal State Budgetary Scientific Institution Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products of the Russian Academy of SciencesRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России; Федеральное государственное автономное учреждение Лечебно-реабилитационный центрРоссияFederal State Autonomous Institution of Higher Education «Pirogov Russian National Research Medical University» of the Russian Ministry of Health; Federal State Autonomous Institution «National Medical Research Center of Rehabilitation» of the Russian Ministry of HealthRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России; Государственное бюджетное учреждение здравоохранения «Городская клиническая больница имени В.М. Буянова» Департамента здравоохранения города МосквыРоссияFederal State Autonomous Institution of Higher Education «Pirogov Russian National Research Medical University» of the Russian Ministry of Health; State Budgetary Healthcare Institution «Buyanov City Clinical Hospital» of the Moscow Healthcare DepartmentRussian Federation202031052020103188197Copyright © Ильченко Л.Ю., Никитин И.Г., Федоров И.Г., 20202020Ильченко Л.Ю., Никитин И.Г., Федоров И.Г.Ilchenko L.Y., Nikitin I.G., Fedorov I.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/1055

В конце декабря 2019 г. в Китайской народной Республике началась вспышка неизвестной пневмонии, вызванная новым коронавиру-сом SARS-CoV-2 (severeacuterespiratorysyndromecoronavirus — коронавирус тяжелого острого респираторного синдрома). Всемирная организация здравоохранения 11 февраля 2020 г. присвоила официальное название SARS-CoV-2-инфекции, — COVID-19 («CoronaVirus Disease 2019» — заболевание, вызванное новым коронавирусом 2019). Пневмония является ведущей клинической формой COVID-19. Однако по мере распространения пандемии COVID-19 и анализа клинических данных у заболевших стали выделять симптомы, не характерные для «аномальной» пневмонии. Описаны неврологические проявления, изменения кожи, поражения глаз и др. Внелегочное присутствие SARS-CoV-2 обнаружено также в холангиоцитах. Среди возможных факторов повреждения печени рассматривается вирус-индуцированное влияние, системное воспаление («цитокиновый шторм»), гипоксия, гиповолемия, гипотония при шоке, лекарственная гепатотоксичность и др. У 14-53% пациентов с COVID-19 могут регистрироваться изменения биохимических показателей, которые, как правило, не требуют медикаментозной коррекции. Весьма редко развивается острый гепатит. Однако особое внимание следует уделять пациентам с COVID-19, относящимся к группе риска — перенесшим трансплантацию печени, получающим иммуносупрессанты, а также в случаях декомпенсации цирроза, развитии острой печеночной недостаточности на фоне хронической, гепатоцеллюлярной карциномы, при проведении противовирусной терапии. Необходим постоянный обмен и открытый доступ к научным данным, новым технологиям, обновляющимся руководствам.

An outbreak of unknown pneumonia, caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), was reported in China at the end of December 2019. On February 11, 2020, the World Health Organization officially named SARS-CoV-2 infection COVID-19 (Coronavirus Disease 2019). The most common clinical manifestation of COVID-19 is pneumonia. However, with the spread of the COVID-19 pandemic and analysis of clinical data, symptoms that are not characteristic of “atypical” pneumonia have been identified in patients. Neurological symptoms, skin and eye damage, etc., are described. The extrapulmonary presence of SARS-CoV-2 was also detected in cholangiocytes. Virus-induced effects, systemic inflammation (“cytokine storm”), hypoxia, hypovolemia, hypotension in shock, drug-induced hepatotoxicity, etc., are considered possible factors of liver damage. In 14-53 % of COVID-19 patients, changes in biochemical parameters, which usually do not require drug therapy, can be recorded. Acute hepatitis is very rare. However, special attention should be given to COVID-19 patients at risk: after liver transplantation; receiving immunosuppressants and antiviral drugs; and in cases of decompensated cirrhosis, acute-on-chronic liver failure, and hepatocellular carcinoma. Constant data sharing and open access to research data, new technologies, and up-to-date guidelines are required.

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