medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-5-84-91medsovet-6169Research ArticleЗАБОЛЕВАНИЯ БИЛИАРНОЙ СИСТЕМЫ И ПЕЧЕНИDISEASES OF THE BILIARY SYSTEM AND LIVERСлучай тяжелого поражения печени при COVID-19Case of severe liver damage in COVID-19ПлотниковаЕ. Ю.PlotnikovaE. Yu.

д.м.н., профессор кафедры подготовки врачей первичного звена здравоохранения, руководитель курса клинической гастроэнтерологии, 

650029, Кемерово, ул. Ворошилова, д. 22а

Dr. Sci. (Med.), Professor of the Department of Polyclinic Therapy, Postgraduate training of doctors and nursing, Head of the Clinical Gastroenterology Course, 

22a, Voroshilov St., Kemerovo, 650029

eka-pl@rambler.ruБарановаЕ. Н.BaranovaE. N.

к.м.н., доцент кафедры госпитальной терапии и клинической фармакологии, 650029, Кемерово, ул. Ворошилова, д. 22а; 

65000, Кемерово, ул. Николая Островского, д. 22, корп. 2

Cand. Sci. (Med.), Associate Professor of Department of Hospital Therapy and Clinical Pharmacology, 22a, Voroshilov St., Kemerovo, 650029;

22, Bldg. 2, Nikolay Ostrovsky St., Kemerovo, 65000

bevgn@rambler.ruКарягинаМ. С.KaryaginaM. S.

врач-гастроэнтеролог гастроэнтерологического отделения Кузбасского гепатологического центра, 

65000, Кемерово, ул. Николая Островского, д. 22, корп. 2

Gastroenterologist, Gastroenterological Department, Kuzbass Hepatology Center, 

22, Bldg. 2, Nikolay Ostrovsky St., Kemerovo, 65000

doctorssmock@yandex.ruВоросоваО. А.VorosovaO. A.

врач-гастроэнтеролог гастроэнтерологического отделения Кузбасского гепатологического центра, 

65000, Кемерово, ул. Николая Островского, д. 22, корп. 2

Gfstroenterologist, Gastroenterological Department, Kuzbass Hepatology Center, 

22, Bldg. 2, Nikolay Ostrovsky St., Kemerovo, 65000

elfi-007@yandex.ruКрасновК. А.KrasnovK. A.

к.м.н., доцент кафедры госпитальной хирургии, 650029, Кемерово, ул. Ворошилова, д. 22а; 

директор Кузбасского гепатологического центра, 65000, Кемерово, ул. Николая Островского, д. 22, корп. 2

Cand. Sci. (Med.), Associate Professor of Department of Hospital Surgery, 22a, Voroshilov St., Kemerovo, 650029;

Director, 22, Bldg. 2, Nikolay Ostrovsky St., Kemerovo, 65000

krasnov8k@rambler.ruКемеровский государственный медицинский университетРоссияKemerovo State Medical UniversityRussian FederationКемеровский государственный медицинский университет; Кузбасская клиническая больница скорой медицинской помощи имени М.А. ПодгорбунскогоРоссияKemerovo State Medical University; Podgorbunsky Kuzbass Clinical Hospital of Emergency Medical CareRussian FederationКузбасская клиническая больница скорой медицинской помощи имени М.А. ПодгорбунскогоРоссияPodgorbunsky Kuzbass Clinical Hospital of Emergency Medical CareRussian FederationКемеровский государственный медицинский университет; Кузбасская клиническая больница скорой медицинской помощи имени М.А. Подгорбунского;РоссияKemerovo State Medical University; Kuzbass Hepatology Center, Podgorbunsky Kuzbass Clinical Hospital of Emergency Medical CareRussian Federation202112052021058491Copyright © Плотникова Е.Ю., Баранова Е.Н., Карягина М.С., Воросова О.А., Краснов К.А., 20212021Плотникова Е.Ю., Баранова Е.Н., Карягина М.С., Воросова О.А., Краснов К.А.Plotnikova E.Y., Baranova E.N., Karyagina M.S., Vorosova O.A., Krasnov K.A.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-sovet.pro/jour/article/view/6169

Вспышка коронавирусного заболевания 2019 г. (COVID-19), вызванного тяжелым острым респираторным синдромом коронавируса 2 (SARS-CoV-2), является глобальной проблемой с декабря 2019 г. Хотя у большинства пациентов с COVID-19 наблюдаются легкие клинические проявления, примерно у 5% этих пациентов заболевание в конечном итоге прогрессирует до тяжелого повреждения легких или даже полиорганной дисфункции. Эта ситуация представляет собой различные проблемы для гепатологии. В  контексте поражения печени у  пациентов с  COVID-19  необходимо решить несколько ключевых проблем. Например, важно определить, может ли SARS-CoV-2 напрямую проникать в печень, особенно в тех случаях, когда кажется, что ACE2 незначительно экспрессируется в гепатоцитах. Кроме того, механизмы, лежащие в основе дисфункции печени у пациентов с COVID-19, являются многофакторными и связаны с гипервоспалением, дисрегулируемыми иммунными ответами, аномальной коагуляцией и  лекарствами. В  статье описывается потенциальный патогенез поражения печени, связанного с  COVID- 19. Гистопатологические данные наводят на  мысль о  заметном нарушении внутрипеченочной сети кровеносных сосудов, вторичном по отношению к системным изменениям, вызванным вирусом, который может запускать каскад коагуляции и повреждать эндотелиальный слой кровеносных сосудов. Также приводится клинический случай полиэтиологического поражения печени у молодого мужчины, приведшего к смерти. На фоне инфекции COVID-19 у пациента возник массивный тромбоз сосудов печени с последующим развитием некроза – фиброза – цирроза – острой печеночной недостаточности, которая явилась причиной летального исхода. 

The 2019 outbreak of coronavirus disease (COVID-19) caused by severe acute coronavirus 2 respiratory syndrome (SARS-CoV-2) has been a  global concern since December 2019. Although most patients with COVID-19  have mild clinical manifestations, in about 5% of these patients the disease eventually progresses to severe lung injury or even multiple organ dysfunction. This situation presents various problems for hepatology. In the context of liver damage in patients with COVID-19, several key problems need to be addressed. For example, it is important to determine whether a SARS-CoV-2 can directly enter the liver, especially when it appears that ACE2 is marginally expressed in hepatocytes. In addition, the mechanisms underlying liver dysfunction in patients with COVID-19 are multifactorial and are associated with hyperinflammation, dysregulated immune responses, abnormal coagulation, and drugs. The  article describes the  potential pathogenesis of  liver damage associated with COVID-19. Histopathological evidence suggests a marked disruption of the intrahepatic network of blood vessels secondary to systemic changes caused by a virus that can trigger a coagulation cascade and damage the endothelial layer of blood vessels. There is also a clinical case of polyethylene damage to the liver in a young man who led to death. Against the background of infection COVID-19 he developed massive thrombosis of the liver vessels, followed by the development of necrosis — fibrosis — cirrhosis — acute liver failure, which caused death.

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