Abstract
COVID-19 pandemic has made the problem of its complex pharmacotherapy urgent, taking into account the common presence of symptoms from the digestive system in the clinical picture. The gastrointestinal tract (GIT) is actively involved in the pathogenesis of COVID-19 both in the period of prodromal events and the acute disease phase, with the preservation of several complaints and during the post-COVID-19 syndrome. The liver is one of the main organs that is commonly affected by COVID-19 after the respiratory system. The polyetiological nature of liver lesions in COVID-19 includes the following: direct viral damage to hepatocytes and cholangiocytes, systemic inflammatory response and cytokine aggression, reactive hepatitis, drug toxicity, hypoxia associated with acute respiratory distress syndrome, as well as sepsis and multiple organ dysfunction in terminal patients. Special attention should be paid to the liver condition in COVID-19 in comorbid patients with metabolic syndrome and non-alcoholic fatty liver disease, as well as chronic liver diseases with a history of viral and autoimmune genesis. Rehabilitation issues concerning patients after COVID-19 are currently under active development. At the same time, the experience of clinical cases leaves no doubt that it is necessary to take into account the hepatobiliary system condition and the presence of comorbidity when implementing rehabilitation programs. Methods customization to the issues of early recovery of post-COVID-19 patients implies knowledge of the differentiated use of hepatotropic drugs based on Russian and foreign clinical recommendations. KEYWORDS: liver diseases, COVID-19, rehabilitation, essential phospholipids, milk thistle extract, non-alcoholic fatty liver disease, cytokine damage, angiotensin converting enzyme, liver transaminases, drug-induced liver injuries. FOR CITATION: Selivanova G.B., Poteshkina N.G. Feasibility of an integrated approach to the treatment of liver diseases in various patients during post-COVID-19 rehabilitation. Russian Medical Inquiry. 2021;5(6):413–420 (in Russ.). DOI: 10.32364/2587-6821-2021- 5-6-413-420.
Highlights
COVID-19 pandemic has made the problem of its complex pharmacotherapy urgent
of the main organs that is commonly affected by COVID-19 after the respiratory system
hypoxia associated with acute respiratory distress syndrome
Summary
COVID-19 pandemic has made the problem of its complex pharmacotherapy urgent, taking into account the common presence of symptoms from the digestive system in the clinical picture. Учитывая огромное бремя хронических заболеваний печени во всем мире [6], можно ожидать, что пандемия COVID-19 поставит новые вопросы тактики лечения данных пациентов в случае несвоевременного скрининга, а также при динамическом наблюдении. Несмотря на эти значительные различия в экспрессии AGE2, холестатический тип повреждения не является патогномоничным признаком поражения печени при COVID-19, о чем также свидетельствует повышение уровня лейцинаминопептидазы и билирубина только в небольшом количестве случаев [9].
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