Rahman Salimur, Khan Mobin, Karim Fazal
Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka 1000, Bangladesh.
J Health Popul Nutr. 2009 Feb;27(1):14-9. doi: 10.3329/jhpn.v27i1.3314.
Acute hepatitis is seen sporadically round the year in Bangladesh. The incidence of acute viral hepatitis E increases after floods as this allows sewerage contamination of piped and groundwater. The aim of this retrospective study was to assess the burden of hepatitis E virus (HEV infection) in Bangladesh. Patients attending the Hepatology Unit III of the Bangabandhu Sheikh Mujib Medical University, during June 2004-December 2006, were included in the study. All viral markers were tested by enzyme-linked immunosorbent assay. The study population was divided in four groups. Group 1 included 144 patients with acute viral hepatitis. The inclusion criteria were: nausea and/or vomiting, loss of appetite, serum bilirubin >200 micromol/L, raised serum transaminases, and prothrombin time >3 seconds prolonged beyond control value. In Group 2, there were 31 pregnant women with acute viral hepatitis. All the patients had prodrome, icterus, raised serum bilirubin and raised serum transaminase levels. Group 3 included 23 patients presenting with fulminant hepatic failure. In Group 4, 69 patients with cirrhosis of liver were included. They presented with features of decompensation for the first time. The inclusion criteria were: patients with established cirrhosis with jaundice and/or ascites and/or hepatic encephalopathy. In Group 1, 58.33% of the 144 patients had acute viral hepatitis E. In Group 2, 45.16% of the pregnant women also had acute viral hepatitis E. HEV was responsible for 56.52% cases of fulminant hepatic failure in Group 3. In 21.7% cases in Group 4, decompensation of cirrhosis was due to HEV. Acute viral hepatitis E in the third trimester of pregnancy and HEV-induced fulminant hepatic failure were associated with 80% of mortality despite the best possible care. In this clinical context, acute viral hepatitis E is the leading cause of wide spectrum of liver disease ranging from severe acute viral hepatitis, fulminant hepatic failure, to decompensation of liver in cirrhotics in Bangladesh. Sewerage contamination of piped water following floods may contribute to the higher incidence of HEV infection.
在孟加拉国，急性肝炎全年散发。洪水过后，急性戊型病毒性肝炎的发病率会上升，因为这会导致管道水和地下水受到污水污染。这项回顾性研究的目的是评估孟加拉国戊型肝炎病毒（HEV）感染的负担。2004年6月至2006年12月期间，在孟加拉国谢赫穆吉布医学大学肝病三科就诊的患者被纳入研究。所有病毒标志物均通过酶联免疫吸附测定法进行检测。研究人群分为四组。第一组包括144例急性病毒性肝炎患者。纳入标准为：恶心和/或呕吐、食欲不振、血清胆红素>200微摩尔/升、血清转氨酶升高以及凝血酶原时间比对照值延长>3秒。第二组有31例急性病毒性肝炎孕妇。所有患者均有前驱症状、黄疸、血清胆红素升高和血清转氨酶水平升高。第三组包括23例暴发性肝衰竭患者。第四组纳入了69例肝硬化患者。他们首次出现失代偿特征。纳入标准为：已确诊肝硬化且伴有黄疸和/或腹水和/或肝性脑病的患者。在第一组的144例患者中，58.33%患有急性戊型病毒性肝炎。在第二组中，45.16%的孕妇也患有急性戊型病毒性肝炎。在第三组中，HEV导致了56.52%的暴发性肝衰竭病例。在第四组中，21.7%的肝硬化失代偿病例是由HEV引起的。尽管给予了最佳治疗，但妊娠晚期的急性戊型病毒性肝炎和HEV引起的暴发性肝衰竭的死亡率仍高达80%。在这种临床背景下，急性戊型病毒性肝炎是孟加拉国一系列肝病的主要病因，从严重急性病毒性肝炎、暴发性肝衰竭到肝硬化患者的肝失代偿。洪水过后管道水受到污水污染可能导致HEV感染发病率升高。
