Forbes A, Williams R
Department of Gastroenterology, West Middlesex University Hospital, Isleworth, UK.
Br Med Bull. 1990 Apr;46(2):303-18. doi: 10.1093/oxfordjournals.bmb.a072400.
The picornavirus responsible for hepatitis A is no longer thought directly cytopathic; it is probable that pathogenesis is dependent on T-cell mediation. Although well known to cause a generally milder illness in young children, it is now clear that the severity of hepatitis A continues to increase steadily with increasing age through adulthood also. Earlier and controversial reports of relapsing hepatitis A are now better supported by investigatory data. Cyclic epidemics are becoming less apparent in the developed world, where particular groups, such as intravenous drug abusers and those in contact with children, account for an increasing proportion of cases. Endemicity is gradually being overcome in developing countries, an effect mainly of improved sanitation, and it has been shown that hepatitis A may disappear entirely from isolated communities.
引发甲型肝炎的微小核糖核酸病毒不再被认为具有直接的细胞病变作用；发病机制可能依赖于T细胞介导。尽管众所周知，该病毒在幼儿中通常引发的病情较轻，但现在很明显，甲型肝炎的严重程度在整个成年期也会随着年龄的增长而持续稳步上升。关于复发性甲型肝炎的早期且有争议的报告，现在有了更多调查数据的有力支持。在发达国家，周期性流行正变得不那么明显，在这些国家，特定群体，如静脉注射吸毒者和与儿童有接触的人，在病例中所占比例越来越大。在发展中国家，地方性流行正逐渐得到控制，这主要是改善卫生条件的结果，并且已经表明，甲型肝炎可能会在与世隔绝的社区中完全消失。
