Случай тяжелого поражения печени при COVID-19

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. 

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