Complicações hepatobiliares em pacientes com covid-19: uma revisão integrativa
DOI:
https://doi.org/10.11606/issn.1679-9836.v102i6e-209103Palavras-chave:
Doenças Hepatobiliares, COVID-19, Gastrointestinal, Fisiopatologia, FígadoResumo
Introdução: Durante o curso clínico do COVID-19, observou-se que a lesão hepática ocorre em uma proporção significativa de pacientes, principalmente naqueles com doença grave ou crítica. Objetivos: Sintetizar as informações disponíveis que abrangem os mecanismos das lesões hepatobiliares induzidas pelo COVID-19. Métodos: Trata-se de uma revisão integrativa da literatura na base de dados PubMed e BVS usando os descritores: “Doenças Hepatobiliares”, “COVID-19”, “Gastrointestinal”, “Fisiopatologia” e “Fígado”. Para aprimoramento da busca foram utilizados os operadores booleanos “AND” e “OR”, e selecionados artigos de relevância para o tema. Inicialmente, foram selecionados 193 artigos, dos últimos 10 anos, em português e/ou inglês. Após análise, 18 artigos corresponderam ao objetivo proposto. Resultados: A disfunção hepática foi observada em 14 a 53% dos pacientes com COVID-19, principalmente naqueles com doença grave. Isso acontece em razão do mecanismo postulado de entrada viral através dos receptores da enzima conversora de angiotensina 2 que estão abundantemente presentes não apenas nas células alveolares tipo 2, mas também no trato gastrointestinal, endotélio vascular e colangiócitos do fígado. O envolvimento hepático no COVID-19 está relacionado com lesão direta por SARS-CoV-2 ao fígado, reação inflamatória sistêmica, lesão hepática por hipóxia, isquemia e reperfusão, agravamento das lesões hepáticas devido a associação das doenças hepáticas preexistentes com a COVID-19 e lesão hepática induzida por drogas. Conclusões: Alterações da função hepática, sobretudo na hipoalbuminemia, elevação de GGT e aminotransferase, são frequentes em pacientes com doença por COVID-19. Inclusive, os pacientes com doença grave, têm maior probabilidade de apresentar esses distúrbios da função hepática.
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