与戊型肝炎病毒感染相关的吉兰-巴雷综合征。
Guillain-Barré syndrome associated with preceding hepatitis E virus infection.
机构信息
From the Departments of Neurology (B.v.d.B., B.C.J.), Viroscience (A.A.v.d.E., S.D.P.), and Immunology (A.P.T.-G., B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Cornwall Gastrointestinal Unit (J.G.H., R.G.M., H.R.D.), Royal Cornwall Hospital Trust, Truro; and European Centre for the Environment and Human Health (J.G.H., R.G.M., H.R.D.), University of Exeter Medical School, Truro, UK.
出版信息
Neurology. 2014 Feb 11;82(6):491-7. doi: 10.1212/WNL.0000000000000111. Epub 2014 Jan 10.
OBJECTIVE
The aim of the study was to determine whether Guillain-Barré syndrome (GBS) is associated with preceding hepatitis E virus infection.
METHODS
The frequency of hepatitis E virus (HEV) infections was determined by anti-HEV serology in a cohort of 201 patients with GBS and 201 healthy controls with a similar distribution in age, sex, and year of sampling. Blood samples from patients with GBS were obtained in the acute phase before treatment. In a subgroup of patients with GBS, blood, stool, and CSF samples were tested for HEV RNA.
RESULTS
An increased ratio of anti-HEV immunoglobulin (Ig) M antibodies was found in 10 patients with GBS (5.0%) compared with 1 healthy control (0.5%, odds ratio 10.5, 95% confidence interval 1.3-82.6, p = 0.026). HEV RNA was detected in blood from 3 of these patients and additionally in feces from 1 patient. Seventy percent of anti-HEV IgM-positive patients had mildly increased liver function tests. All CSF samples tested negative for HEV RNA. The presence of anti-HEV IgM in patients with GBS was not related to age, sex, disease severity, or clinical outcome after 6 months.
CONCLUSIONS
In the Netherlands, 5% of patients with GBS have an associated acute HEV infection. Further research is required to determine whether HEV infections also precede GBS in other geographical areas.
目的
本研究旨在确定吉兰-巴雷综合征（GBS）是否与戊型肝炎病毒（HEV）感染有关。
方法
通过抗 HEV 血清学检测，在 201 例 GBS 患者和 201 例年龄、性别和采样年份相似的健康对照者中，确定 HEV 感染的频率。GBS 患者的血液样本在治疗前的急性期采集。在 GBS 患者的亚组中，检测血液、粪便和 CSF 样本中的 HEV RNA。
结果
与 1 例健康对照者（0.5%）相比，10 例 GBS 患者（5.0%）中发现抗 HEV 免疫球蛋白（Ig）M 抗体的比值升高（比值比 10.5，95%置信区间 1.3-82.6，p = 0.026）。其中 3 例患者的血液中检测到 HEV RNA，另外 1 例患者的粪便中也检测到 HEV RNA。70%的抗 HEV IgM 阳性患者的肝功能检查略有升高。所有 CSF 样本均未检测到 HEV RNA。GBS 患者抗 HEV IgM 的存在与年龄、性别、疾病严重程度或 6 个月后的临床结局无关。
结论
在荷兰，5%的 GBS 患者存在急性 HEV 感染。需要进一步研究以确定在其他地理区域 HEV 感染是否也先于 GBS 发生。
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