Departments of Nephrology and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR-BMT, Université Paul Sabatier, TSA 50032, 31059 Toulouse Cedex 9, Toulouse, France.
Department of Virology, CHU Purpan, INSERM U1043, IFR-BMT, Université Paul Sabatier, Toulouse, France.
Nat Rev Dis Primers. 2017 Nov 16;3:17086. doi: 10.1038/nrdp.2017.86.
Hepatitis E virus (HEV) infection can lead to acute and chronic hepatitis as well as to extrahepatic manifestations such as neurological and renal disease; it is the most common cause of acute viral hepatitis worldwide. Four genotypes are responsible for most infection in humans, of which HEV genotypes 1 and 2 are obligate human pathogens and HEV genotypes 3 and 4 are mostly zoonotic. Until quite recently, HEV was considered to be mainly responsible for epidemics of acute hepatitis in developing regions owing to contamination of drinking water supplies with human faeces. However, HEV is increasingly being recognized as endemic in some developed regions. In this setting, infections occur through zoonotic transmission or contaminated blood products and can cause chronic hepatitis in immunocompromised individuals. HEV infections can be diagnosed by measuring anti-HEV antibodies, HEV RNA or viral capsid antigen in blood or stool. Although an effective HEV vaccine exists, it is only licensed for use in China. Acute hepatitis E is usually self-limiting and does not require specific treatment. Management of immunocompromised individuals involves lowering the dose of immunosuppressive drugs and/or treatment with the antiviral agent ribavirin.
戊型肝炎病毒（HEV）感染可导致急性和慢性肝炎以及肝外表现，如神经和肾脏疾病；它是全球最常见的急性病毒性肝炎病因。有 4 种基因型可导致人类的大多数感染，其中 HEV 基因型 1 和 2 是强制性人类病原体，HEV 基因型 3 和 4 主要是动物源性的。直到最近，由于饮用水受到人类粪便污染，HEV 被认为主要导致发展中地区的急性肝炎流行。然而，HEV 在一些发达国家也越来越被认为是地方性的。在这种情况下，感染通过动物源性传播或受污染的血液制品发生，并可导致免疫功能低下个体的慢性肝炎。可通过检测血液或粪便中的抗-HEV 抗体、HEV RNA 或病毒衣壳抗原来诊断 HEV 感染。虽然存在有效的 HEV 疫苗，但仅在中国获得许可使用。急性戊型肝炎通常是自限性的，不需要特定的治疗。免疫功能低下个体的管理包括降低免疫抑制药物的剂量和/或用抗病毒药物利巴韦林治疗。
