Pischke Sven, Behrendt Patrick, Bock Claus-Thomas, Jilg Wolfgang, Manns Michael P, Wedemeyer Heiner
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hanover, German Centre for Infection Research, Hanover, TWINCORE Institute for Experimental Infection Research, Hanover, Health Care Center at the University Medical Center Hamburg-Eppendorf, Robert Koch Institute Berlin, Consiliary Laboratory for Hepatitis A and Hepatitis E, Institute for Medical Microbiology and Hygiene, University Hospital Regensburg, Regensburg.
Dtsch Arztebl Int. 2014 Sep 1;111(35-36):577-83. doi: 10.3238/arztebl.2014.0577.
At least 17% of the population in Germany has been infected with the hepatitis E virus (HEV); thus, HEV infections are more frequent than was previously assumed. However, fewer than 500 HEV infections were reported to the Robert Koch Institute in 2013.
Review of pertinent literature retrieved by a selective search in PubMed.
Persons living in Germany generally acquire hepatitis E infection within the country by consuming infected and undercooked pork; in rare cases, hepatitis E infections are imported from the tropics. HEV can be transmitted via blood products, blood transfusions, and organ transplantation. More than 99% of HEV infections are asymptomatic and self-limiting, but there are also severe cases with acute liver failure. Immunosuppressed persons can develop chronic HEV infection, potentially leading, within a few years, to liver cirrhosis with life-threatening sequelae. Moreover, HEV infection may be associated with extrahepatic manifestations such as Guillain-Barré syndrome. In two retrospectively evaluated case series, ribavirin was found to be active against HEV and can be used to treat either acute or chronic HEV infection.
Hepatitis E must be considered in the differential diagnosis of elevated hepatic enzyme levels and of systemic and neurological conditions of uncertain origin. The infection is usually self-limiting but can take a severe course in immunosuppressed persons. In such cases, ribavirin can be used as an antiviral treatment.
德国至少17%的人口曾感染戊型肝炎病毒（HEV）；因此，戊型肝炎感染比之前认为的更为常见。然而，2013年向德国罗伯特·科赫研究所报告的戊型肝炎感染病例不到500例。
通过在PubMed中进行选择性检索，回顾相关文献。
居住在德国的人通常通过食用受感染的未煮熟猪肉在国内感染戊型肝炎；在极少数情况下，戊型肝炎感染是从热带地区输入的。戊型肝炎可通过血液制品、输血和器官移植传播。超过99%的戊型肝炎感染无症状且为自限性，但也有严重病例会出现急性肝衰竭。免疫抑制者可发生慢性戊型肝炎感染，可能在数年内导致肝硬化并出现危及生命的后遗症。此外，戊型肝炎感染可能与吉兰 - 巴雷综合征等肝外表现有关。在两个回顾性评估的病例系列中，发现利巴韦林对戊型肝炎有活性，可用于治疗急性或慢性戊型肝炎感染。
在对肝酶水平升高以及病因不明的全身和神经系统疾病进行鉴别诊断时，必须考虑戊型肝炎。该感染通常为自限性，但在免疫抑制者中可能会发展为重症。在这种情况下，利巴韦林可作为抗病毒治疗药物。
