Kar Premashis, Jilani Nishat, Husain Syed A, Pasha Sayed Tazeen, Anand Ranjana, Rai Arvind, Das Bhudev C
PCR Hepatitis Laboratory, Department of Medicine, Maulana Azad Medical College, New Delhi, India.
Am J Gastroenterol. 2008 Oct;103(10):2495-501. doi: 10.1111/j.1572-0241.2008.02032.x. Epub 2008 Sep 10.
Hepatitis E is a major health problem in developing countries including India. The incidence and mortality rate in pregnant women with fulminant hepatic failure (FHF) due to hepatitis E virus (HEV) has been reported to be significantly higher, specifically in Asian women. Pregnancy is usually associated with an altered status of sex steroid hormones and immunity. Steroid hormones directly influence the replication through their effects on viral regulatory elements. Moreover, pregnant women in Asia generally suffer from folate deficiency, which is known to cause reduced immunocompetence leading to greater risk of multiple viral infections and higher viral load.
To correlate and analyze the viral load and genotypes of HEV in acute liver failure with that of acute viral hepatitis among pregnant and nonpregnant women.
A total of 100 FHF and 150 acute viral hepatitis (AVH) patients (50, 75 pregnant and 50, 75 nonpregnant, respectively), were included in the study. These cases were evaluated on the basis of history, clinical examination, liver function profile, and serological test of hepatitis A, B, C, and E using commercially available ELISA kits. Quantification of HEV RNA-positive samples was carried out.
Out of 100 FHF and 150 acute viral hepatitis (AVH) patients, 28 (56%) and 22 (29.3%) pregnant and 7 (14%) and 8 (16%) nonpregnant, respectively, were HEV RNA-positive. HEV viral load in FHF pregnant women was 5.87 x 10(4)+/- 1.5 x 10(5) microL/mL as compared to AVH pregnant women 343.29 +/- 216.44 microL/mL and FHF and AVH nonpregnant 199.2 +/- 225.5 microL/mL and 13.83 +/- 7.8 microL/mL, respectively. Sequencing data of all the positive samples of FHF and AVH pregnant and nonpregnant women showed genotype 1.
HEV viral load was found to be significantly higher (P < 0.05) in pregnant patients compared to the nonpregnant. Pregnancy appears to be a risk factor for viral replication. The viral copies of HEV in FHF pregnant women were comparatively higher when compared to AVH pregnant women, which may be related to the severity of the disease in these patients. We could detect only one genotype (genotype 1) in our study population. Thus in the absence of other genotypes in this population, the impact of genotype could not be adequately assessed in this study.
戊型肝炎是包括印度在内的发展中国家的一个主要健康问题。据报道，戊型肝炎病毒（HEV）导致的暴发性肝衰竭（FHF）在孕妇中的发病率和死亡率显著更高，尤其是在亚洲女性中。妊娠通常与性类固醇激素和免疫状态的改变有关。类固醇激素通过对病毒调节元件的作用直接影响病毒复制。此外，亚洲孕妇普遍存在叶酸缺乏，已知这会导致免疫能力下降，从而增加多种病毒感染的风险和病毒载量。
比较并分析孕妇和非孕妇急性肝衰竭与急性病毒性肝炎中HEV的病毒载量和基因型。
本研究共纳入100例FHF患者和150例急性病毒性肝炎（AVH）患者（分别为50例、75例孕妇和50例、75例非孕妇）。这些病例根据病史、临床检查、肝功能指标以及使用市售ELISA试剂盒进行的甲型、乙型、丙型和戊型肝炎血清学检测进行评估。对HEV RNA阳性样本进行定量分析。
在100例FHF患者和150例急性病毒性肝炎（AVH）患者中，分别有28例（56%）和22例（29.3%）孕妇以及7例（14%）和8例（16%）非孕妇HEV RNA呈阳性。FHF孕妇的HEV病毒载量为5.87×10(4)±1.5×10(5)微升/毫升，而AVH孕妇为343.29±216.44微升/毫升，FHF和AVH非孕妇分别为199.2±225.5微升/毫升和13.83±7.8微升/毫升。FHF和AVH孕妇及非孕妇所有阳性样本的测序数据均显示为1型基因型。
发现孕妇的HEV病毒载量显著高于非孕妇（P<0.05）。妊娠似乎是病毒复制的一个危险因素。与AVH孕妇相比，FHF孕妇的HEV病毒拷贝数相对较高，这可能与这些患者疾病的严重程度有关。在我们的研究人群中仅检测到一种基因型（1型基因型）。因此，由于该人群中不存在其他基因型，本研究无法充分评估基因型的影响。
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