Rezende Guilhermo, Roque-Afonso Anne Marie, Samuel Didier, Gigou Michele, Nicand Elisabeth, Ferre Virginie, Dussaix Elisabeth, Bismuth Henri, Féray Cyrille
Centre Hépato-Biliaire, Equipe Propre de l'Institut National de la Santé, Unité propre de recherche de l'enseignement supérieur No. 3541, Formation de recherche associée à l'Association Claude Bernard, Villejuif, France.
Hepatology. 2003 Sep;38(3):613-8. doi: 10.1053/jhep.2003.50366.
Fulminant hepatitis is a severe complication of hepatitis A virus infection. Its mechanism is unknown. Liver transplantation can be necessary, but spontaneous recovery is frequent. There are no data on the level of viral replication according to the clinical form of hepatitis A. We reviewed the files of 50 patients with acute hepatitis A. Nineteen patients had fulminant hepatitis (defined by encephalopathy and factor V <50%), and, from them, 10 patients underwent transplantation. Hepatitis A virus (HAV) RNA was quantified by real-time PCR on sera obtained at admission. The genotype was determined by phylogenetic analysis of HAV RNA. HAV RNA was detected in serum by RT-PCR in 39 out of 50 patients. Encephalopathy and low factor V level were significantly related to female gender, HAV PCR negativity (9/19 vs. 5/31, respectively; P =.03), a low serum HAV RNA level (log, 3.6 +/- 0.6 vs. 4.4 +/- 0.9, respectively; P =.02), genotypes other than IA, and acetaminophen intake. In multivariate analysis, low or undetectable HAV viral load and a high bilirubin level were independently associated with both low factor V levels and fulminant hepatitis and also with death or transplantation. In conclusion, HAV-related liver failure is due to an excessive host response associated with a marked reduction in viral load. Serum HAV RNA assay could be of help in the management of severe hepatitis A.
暴发性肝炎是甲型肝炎病毒感染的一种严重并发症。其发病机制尚不清楚。可能需要进行肝移植，但经常会出现自发恢复的情况。目前尚无关于甲型肝炎临床类型与病毒复制水平关系的数据。我们回顾了50例急性甲型肝炎患者的病历。19例患者患有暴发性肝炎（根据肝性脑病和凝血因子V<50%定义），其中10例患者接受了移植。入院时采集的血清通过实时聚合酶链反应（PCR）对甲型肝炎病毒（HAV）RNA进行定量。通过对HAV RNA进行系统发育分析确定基因型。50例患者中有39例通过逆转录PCR（RT-PCR）在血清中检测到HAV RNA。肝性脑病和低凝血因子V水平与女性性别、HAV PCR阴性（分别为9/19和5/31；P=0.03）、血清HAV RNA水平低（对数分别为3.6±0.6和4.4±0.9；P=0.02）、非IA基因型以及对乙酰氨基酚摄入显著相关。多变量分析显示，HAV病毒载量低或检测不到以及高胆红素水平与低凝血因子V水平和暴发性肝炎独立相关，也与死亡或移植相关。总之，HAV相关的肝衰竭是由于宿主反应过度且病毒载量显著降低所致。血清HAV RNA检测可能有助于严重甲型肝炎的管理。
