神经痛性肌萎缩与戊型肝炎病毒感染。
Neuralgic amyotrophy and hepatitis E virus infection.
机构信息
From the Department of Neurology (J.J.J.v.E., N.v.A., B.G.M.v.E.), Radboud University Nijmegen Medical Centre; Department of Neurology (J.J.J.v.E.), Jeroen Bosch Hospital, Nijmegen, the Netherlands; Cornwall Gastrointestinal Unit (R.G.M., J.G.H., L.B., L.S., H.R.D.), Clinical Microbiology (R.P.B., V.E.), and Department of Neurology (B.M.), Royal Cornwall Hospital Trust; European Centre for the Environment and Human Health (R.G.M., J.G.H., R.P.B., L.B., H.R.D.), University of Exeter Medical School, Truro, UK; Centre for Infectious Disease Control (J.H.J.R.), Division Virology, National Institute for Public Health and the Environment, Bilthoven; Departments of Viroscience (A.A.v.d.E., S.D.P.), Immunology (B.C.J.), and Neurology (B.C.J.), Erasmus Medical Centre, University Medical Center Rotterdam, the Netherlands.
出版信息
Neurology. 2014 Feb 11;82(6):498-503. doi: 10.1212/WNL.0000000000000112. Epub 2014 Jan 8.
OBJECTIVE
To determine whether there is an association between an acute preceding hepatitis E virus (HEV) infection and neuralgic amyotrophy (NA), and if so, whether patients with HEV-related NA differ from patients without an associated HEV infection.
METHODS
HEV testing was conducted in a retrospective cohort of 28 Cornish patients with NA (2011-2013) and a prospective cohort of 38 consecutive Dutch patients with NA (2004-2007). Acute-phase serum samples were analyzed for the presence of anti-HEV immunoglobulin (Ig) M and IgG and HEV RNA (quantitative real-time PCR).
RESULTS
Five cases (10.6%) of acute hepatitis E infection were identified in a total group of 47 patients with NA of whom serum samples were available. In 4 patients, HEV RNA was detected in serum samples taken at presentation. All patients with HEV-associated NA had clinical and electrophysiologic evidence of bilateral brachial plexus involvement. Anti-HEV IgM positivity was not related to age, sex, disease severity, disease course, or outcome.
CONCLUSIONS
Acute hepatitis E is found in 10% of patients with NA from the United Kingdom and the Netherlands. Further research is required to investigate the role of HEV in NA in other geographical locations and to determine pathophysiologic mechanisms.
目的
确定急性戊型肝炎病毒 (HEV) 感染与神经痛性肌萎缩 (NA) 之间是否存在关联，如果存在，那么与 HEV 相关的 NA 患者是否与无相关 HEV 感染的患者存在差异。
方法
对 28 例英国科尼什（Cornish）NA 患者（2011-2013 年）的回顾性队列和 38 例荷兰连续 NA 患者（2004-2007 年）的前瞻性队列进行了 HEV 检测。对急性期血清样本进行抗 HEV 免疫球蛋白 (Ig) M 和 IgG 以及 HEV RNA（实时定量 PCR）检测。
结果
在总共 47 例可获得血清样本的 NA 患者中，发现了 5 例（10.6%）急性戊型肝炎感染病例。在 4 例患者中，在出现时的血清样本中检测到了 HEV RNA。所有与 HEV 相关的 NA 患者均具有双侧臂丛受累的临床和电生理证据。抗 HEV IgM 阳性与年龄、性别、疾病严重程度、病程或结局无关。
结论
在来自英国和荷兰的 NA 患者中，有 10%发现了急性戊型肝炎。需要进一步研究以调查 HEV 在其他地理位置的 NA 中的作用，并确定病理生理机制。
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