PDF下载 ( 695 KB)
肝硬化合并新型冠状病毒感染的临床特征和管理
DOI: 10.12449/JCH260126
利益冲突声明：本文不存在任何利益冲突。
作者贡献声明：蒋文丽负责论文构思、设计及撰写；罗磊负责论文修订、指导、质量控制及审校；杨文龙负责指导撰写文章以及文章审阅。
Clinical features and management of liver cirrhosis comorbid with severe acute respiratory syndrome coronavirus 2 infection
-
摘要: 肝硬化患者因免疫功能障碍，更易受到各种细菌或病毒感染。近年多项研究显示，与正常人群相比，肝硬化患者感染新型冠状病毒后，肝损伤进展、病死率升高等不良结局的发生率显著升高。接种疫苗能减少肝硬化人群的病毒突破性感染和重症新型冠状病毒感染发生率，但该类人群的免疫应答性较低，需接种加强针巩固免疫应答。本文对肝硬化患者合并新型冠状病毒感染后的临床特征及管理策略进行综述，以期为该类患者的临床诊疗提供参考。
-
关键词:
- 肝硬化 /
- 新型冠状病毒肺炎 /
- COVID-19疫苗 /
- 临床管理
Abstract: Patients with liver cirrhosis are more susceptible to various bacterial or viral infections due to immune dysfunction. Recent studies have shown that compared with the general population， individuals with liver cirrhosis show a significant increase in the incidence rate of adverse outcomes after severe acute respiratory syndrome coronavirus 2 infection， including the progression of liver injury and the increase in mortality rate. Vaccination can reduce the incidence rates of breakthrough infections and severe coronavirus disease 2019 （COVID-19） in patients with liver cirrhosis， but such patients have low immune response and thus require booster doses to enhance immunity. This article reviews the clinical features of cirrhotic patients with COVID-19 and related management strategies， in order to provide evidence-based guidance for the clinical diagnosis and treatment of such patients.-
Key words:
- Liver Cirrhosis /
- COVID-19 /
- COVID-19 Vaccines /
- Clinical Governance
-
[1] COVID-19 cases | WHO COVID-19 dashboard[EB/OL].( 2024-11-23)[ 2025-02-25]. https://data.who.int/dashboards/covid19/cases. https://data.who.int/dashboards/covid19/cases [2] ALKHATIB M, SALPINI R, CARIOTI L, et al. Update on SARS-CoV-2 Omicron variant of concern and its peculiar mutational profile[J]. Microbiol Spectr, 2022, 10( 2): e02732-21. DOI: 10.1128/spectrum.02732-21. [3] Chinese Center for Disease Control and Prevention. National COVID-19 infection situation(January 2025)[EB/OL].( 2025-02-13)[ 2025-02-25]. https://www.chinacdc.cn/jksj/xgbdyq/202502/t20250213_304257.html. https: //www.chinacdc.cn/jksj/xgbdyq/202502/t20250213_304257.html中国疾病预防控制中心. 全国新型冠状病毒感染疫情情况( 2025 年1月)[EB/OL].( 2025-02-13)[ 2025-02-25]. https://www.chinacdc.cn/jksj/xgbdyq/202502/t20250213_304257.html. https: //www.chinacdc.cn/jksj/xgbdyq/202502/t20250213_304257.html [4] DEVARBHAVI H, ASRANI SK, ARAB JP, et al. Global burden of liver disease: 2023 update[J]. J Hepatol, 2023, 79( 2): 516- 537. DOI: 10.1016/j.jhep.2023.03.017. [5] ASRANI SK, DEVARBHAVI H, EATON J, et al. Burden of liver diseases in the world[J]. J Hepatol, 2019, 70( 1): 151- 171. DOI: 10.1016/j.jhep.2018.09.014. [6] IAVARONE M, D’AMBROSIO R, SORIA A, et al. High rates of 30-day mortality in patients with cirrhosis and COVID-19[J]. J Hepatol, 2020, 73( 5): 1063- 1071. DOI: 10.1016/j.jhep.2020.06.001. [7] American Association for the Study of Liver Diseases. AASLD expert panel consensus statement: COVID-19 clinical best practice advice for hepatology and liver transplant providers[EB/OL].( 2022-10-06)[ 2025-02-25]. https://www.aasld.org/sites/default/files/2022-10/AASLD%20COVID-19%20Guidance%20Document%2010.06.2022F.pdf https: //www.aasld.org/sites/default/files/2022-10/AASLD%20COVID-19%20Guidance%20Document%2010.06.2022F.pdf [8] GE J, PLETCHER MJ, LAI JC. Outcomes of SARS-CoV-2 infection in patients with chronic liver disease and cirrhosis: A national COVID cohort collaborative study[J]. Gastroenterology, 2021, 161( 5): 1487- 1501. e 5. DOI: 10.1053/j.gastro.2021.07.010. [9] RABAAN AA, SMAJLOVIĆ S, TOMBULOGLU H, et al. SARS-CoV-2 infection and multi-organ system damage: A review[J]. Biomol Biomed, 2023, 23( 1): 37- 52. DOI: 10.17305/bjbms.2022.7762. [10] KUKLA M, SKONIECZNA-ŻYDECKA K, KOTFIS K, et al. COVID-19, MERS and SARS with concomitant liver injury-systematic review of the existing literature[J]. J Clin Med, 2020, 9( 5): 1420. DOI: 10.3390/jcm9-051420. [11] PAZGAN-SIMON M, SERAFIŃSKA S, KUKLA M, et al. Liver injury in patients with COVID-19 without underlying liver disease[J]. J Clin Med, 2022, 11( 2): 308. DOI: 10.3390/jcm11020308. [12] LUXENBURGER H, THIMME R. SARS-CoV-2 and the liver: Clinical and immunological features in chronic liver disease[J]. Gut, 2023, 72( 9): 1783- 1794. DOI: 10.1136/gutjnl-2023-329623. [13] SARIN SK, CHOUDHURY A, LAU GK, et al. Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study(APASL COVID-19 Liver Injury Spectrum Study)[J]. Hepatol Int, 2020, 14( 5): 690- 700. DOI: 10.1007/s12072-020-10072-8. [14] MARJOT T, MOON AM, COOK JA, et al. Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study[J]. J Hepatol, 2021, 74( 3): 567- 577. DOI: 10.1016/j.jhep.2020.09.024. [15] KUMAR P, SHARMA M, SULTHANA SF, et al. Severe acute respiratory syndrome coronavirus 2-related acute-on-chronic liver failure[J]. J Clin Exp Hepatol, 2021, 11( 3): 404- 406. DOI: 10.1016/j.jceh.2020.12.007. [16] MARJOT T, WEBB GJ, BARRITT AS 4th, et al. COVID-19 and liver disease: Mechanistic and clinical perspectives[J]. Nat Rev Gastroenterol Hepatol, 2021, 18( 5): 348- 364. DOI: 10.1038/s41575-021-00426-4. [17] ZANG CX, HOU Y, SCHENCK EJ, et al. Identification of risk factors of Long COVID and predictive modeling in the RECOVER EHR cohorts[J]. Commun Med(Lond), 2024, 4( 1): 130. DOI: 10.1038/s43856-024-00549-0. [18] SATAPATHY SK, ROTH NC, KVASNOVSKY C, et al. Risk factors and outcomes for acute-on-chronic liver failure in COVID-19: A large multi-center observational cohort study[J]. Hepatol Int, 2021, 15( 3): 766- 779. DOI: 10.1007/s12072-021-10181-y. [19] HIPPISLEY-COX J, COUPLAND CA, MEHTA N, et al. Risk prediction of covid-19 related death and hospital admission in adults after covid-19 vaccination: National prospective cohort study[J]. BMJ, 2021, 374: n2244. DOI: 10.1136/bmj.n2244. [20] KULKARNI AV, METAGE CS, GORA BA, et al. SARS-CoV-2 Omicron variant infection was associated with higher morbidity in patients with cirrhosis[J]. Gut, 2023, 72( 10): 1995- 1996. DOI: 10.1136/gutjnl-2022-328451. [21] GE J, FAR AT, DIGITALE JC, et al. Decreasing case fatality rates for patients with cirrhosis infected with SARS-CoV-2: A national COVID cohort collaborative study[J]. Clin Gastroenterol Hepatol, 2025, 23( 4): 591- 601. e 2. DOI: 10.1016/j.cgh.2024.07.028. [22] MENDIZABAL M, RIDRUEJO E, PIÑERO F, et al. Comparison of different prognostic scores for patients with cirrhosis hospitalized with SARS-CoV-2 infection[J]. Ann Hepatol, 2021, 25: 100350. DOI: 10.1016/j.aohep.2021.100350. [23] AI JW, WANG JT, LIU DX, et al. Safety and immunogenicity of SARS-CoV-2 vaccines in patients with chronic liver diseases(CHESS-NMCID 2101): A multicenter study[J]. Clin Gastroenterol Hepatol, 2022, 20( 7): 1516- 1524. e 2. DOI: 10.1016/j.cgh.2021.12.022. [24] GE J, DIGITALE JC, PLETCHER MJ, et al. Breakthrough SARS-CoV-2 infection outcomes in vaccinated patients with chronic liver disease and cirrhosis: A National COVID Cohort Collaborative study[J]. Hepatology, 2023, 77( 3): 834- 850. DOI: 10.1002/hep.32780. [25] JOHN BV, DENG YY, SCHEINBERG A, et al. Association of BNT162b2 mRNA and mRNA-1273 vaccines with COVID-19 infection and hospitalization among patients with cirrhosis[J]. JAMA Intern Med, 2021, 181( 10): 1306- 1314. DOI: 10.1001/jamainternmed.2021.4325. [26] SIMÃO AL, SANTOS PALMA C, IZQUIERDO-SANCHEZ L, et al. Cirrhosis is associated with lower serological responses to COVID-19 vaccines in patients with chronic liver disease[J]. JHEP Rep, 2023, 5( 5): 100697. DOI: 10.1016/j.jhepr.2023.100697. [27] AL-DURY S, WAERN J, WALDENSTRÖM J, et al. Impaired SARS-CoV-2-specific T-cell reactivity in patients with cirrhosis following mRNA COVID-19 vaccination[J]. JHEP Rep, 2022, 4( 7): 100496. DOI: 10.1016/j.jhepr.2022.100496. [28] BASHO K, ZOLDAN K, SCHULTHEISS M, et al. IL-2 contributes to cirrhosis-associated immune dysfunction by impairing follicular T helper cells in advanced cirrhosis[J]. J Hepatol, 2021, 74( 3): 649- 660. DOI: 10.1016/j.jhep.2020.10.012. [29] CHEN ZW, ZHANG YZ, SONG R, et al. Waning humoral immune responses to inactivated SARS-CoV-2 vaccines in patients with severe liver disease[J]. Signal Transduct Target Ther, 2022, 7( 1): 174. DOI: 10.1038/s41392-022-01032-9. [30] JOHN BV, BASTAICH DR, FERREIRA RD, et al. COVID-19 vaccine effectiveness and community prevalence of Alpha, Delta and Omicron variants in patients with cirrhosis[J]. Gut, 2023, 72( 9): 1800- 1802. DOI: 10.1136/gutjnl-2022-327799. [31] CDC. Interim clinical considerations for use of COVID-19 vaccines in the United States[EB/OL].( 2024-07-28)[ 2025-02-25]. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html. https: //www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html [32] Experts’ recommendations on vaccination against novel coronavirus in adults with special health conditions. Advice from novel coronavirus vaccination experts for adults with special health conditions[J]. Shanghai Med J, 2023, 46( 6): 345- 358. DOI: 10.19842/j.cnki.issn.0253-9934.2023.06.001.特殊健康状况成人新型冠状病毒疫苗接种专家建议编写组. 特殊健康状况成人新型冠状病毒疫苗接种专家建议[J]. 上海医学, 2023, 46( 6): 345- 358. DOI: 10.19842/j.cnki.issn.0253-9934.2023.06.001. [33] MARJOT T, EBERHARDT CS, BOETTLER T, et al. Impact of COVID-19 on the liver and on the care of patients with chronic liver disease, hepatobiliary cancer, and liver transplantation: An updated EASL position paper[J]. J Hepatol, 2022, 77( 4): 1161- 1197. DOI: 10.1016/j.jhep.2022.07.008. [34] HSU WH, SHIAU BW, LIU TH, et al. Clinical effectiveness of nirmatrelvir plus ritonavir in the treatment of COVID-19 in patients with cirrhosis[J]. Expert Rev Anti Infect Ther, 2023, 21( 10): 1143- 1151. DOI: 10.1080/14787210.2023.2267846. [35] ZHAN YQ, LIN ZS, LIANG JY, et al. Leritrelvir for the treatment of mild or moderate COVID-19 without co-administered ritonavir: A multicentre randomised, double-blind, placebo-controlled phase 3 trial[J]. EClinicalMedicine, 2023, 67: 102359. DOI: 10.1016/j.eclinm.2023.102359. [36] LI CY, MAI JJ, WU M, et al. Single-dose tolerability and pharmacokinetics of leritrelvir in Chinese patients with hepatic impairment and healthy matched controls[J]. Antimicrob Agents Chemother, 2025, 69( 2): e0137724. DOI: 10.1128/aac.01377-24. [37] HUANG HP, CHEN QX, YU T, et al. Safety analysis of azivudine tablets in the treatment of coronavirus disease 2019[J]. Adverse Drug React J, 2023, 25( 1): 17- 20. DOI: 10.3760/cma.j.cn114015-20220928-00881.黄红萍, 陈清心, 于阗, 等. 阿兹夫定片治疗新型冠状病毒感染的安全性分析[J]. 药物不良反应杂志, 2023, 25( 1): 17- 20. DOI: 10.3760/cma.j.cn114015-20220928-00881. [38] SHEN YZ, AI JW, LIN N, et al. An open, prospective cohort study of VV116 in Chinese participants infected with SARS-CoV-2 Omicron variants[J]. Emerg Microbes Infect, 2022, 11( 1): 1518- 1523. DOI: 10.1080/22221751.2022.2078230. [39] ERICKSON R, HUANG C, ALLEN C, et al. SARS-CoV-2 infection of human lung epithelial cells induces TMPRSS-mediated acute fibrin deposition[J]. Nat Commun, 2023, 14( 1): 6380. DOI: 10.1038/s41467-023-42140-6. [40] LI Z, GAO FB, WU YY, et al. An excerpt of WGO guidance for the care of patients with COVID-19 and liver disease[J]. J Clin Hepatol, 2021, 37( 3): 554- 555. DOI: 10.3969/j.issn.1001-5256.2021.03.010.李喆, 高方博, 吴艳艳, 等.《世界胃肠病组织指导意见: COVID-19和肝病患者的照护》摘译[J]. 临床肝胆病杂志, 2021, 37( 3): 554- 555. DOI: 10.3969/j.issn.1001-5256.2021.03.010. [41] MORENS DM, TAUBENBERGER JK, FAUCI AS. Universal coronavirus vaccines: An urgent need[J]. N Engl J Med, 2022, 386( 4): 297- 299. DOI: 10.1056/nejmp2118468. [42] ZHAO CY, CAI GN, JIANG S, et al. Broad-spectrum coronavirus neutralization induced by hetero RBD-Fc protein vaccine[J]. J Med Virol, 2024, 96( 9): e29917. DOI: 10.1002/jmv.29917. -
本文二维码
计量
- 文章访问数: 5
- HTML全文浏览量: 1
- PDF下载量: 2
- 被引次数: 0
下载:
