Miura Yoshifumi, Kanda Tatsuo, Yasui Shin, Takahashi Koji, Haga Yuki, Sasaki Reina, Nakamura Masato, Wu Shuang, Nakamoto Shingo, Arai Makoto, Nishizawa Tsutomu, Okamoto Hiroaki, Yokosuka Osamu
Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
Department of Molecular Virology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
Clin J Gastroenterol. 2017 Feb;10(1):52-56. doi: 10.1007/s12328-016-0700-5. Epub 2016 Nov 15.
We describe a case of acute liver failure (ALF) without hepatic encephalopathy with marked elevation of aminotransferase due to hepatitis A, according to the revised Japanese criteria of ALF. This liver biopsy of the patient showed compatible to acute viral hepatitis and she immediately recovered without intensive care. She had no comorbid disorders. Of interest, phylogenetic tree analysis using almost complete genomes of hepatitis A virus (HAV) demonstrated that the HAV isolate from her belonged to the HAV subgenotype IA strain and was similar to the HAJFF-Kan12 strain (99% nucleotide identity) or FH1 strain (98% nucleotide identity), which is associated with severe or fulminant hepatitis A. Careful interpretation of the association between HAV genome variations and severity of hepatitis A is needed and the mechanism of the severe hepatitis should be explored.
根据修订后的日本急性肝衰竭（ALF）标准，我们描述了一例因甲型肝炎导致转氨酶显著升高的无肝性脑病的急性肝衰竭病例。该患者的肝活检显示与急性病毒性肝炎相符，且未经重症监护即迅速康复。她没有合并症。有趣的是，使用甲型肝炎病毒（HAV）几乎完整的基因组进行系统发育树分析表明，从她体内分离出的HAV属于HAV亚基因型IA株，与HAJFF-Kan12株（核苷酸同一性为99%）或FH1株（核苷酸同一性为98%）相似，这两种毒株都与严重或暴发性甲型肝炎有关。需要仔细解读HAV基因组变异与甲型肝炎严重程度之间的关联，并探索严重肝炎的发病机制。
