Laboratory of Immunology and Infectious Diseases, Graduate School of Medical Science and Engineering, KAIST, Daejeon 34141, Republic of Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Gyeonggido 13620, Republic of Korea.
Cold Spring Harb Perspect Med. 2018 Sep 4;8(9):a031708. doi: 10.1101/cshperspect.a031708.
Hepatitis A virus (HAV) is transmitted by the fecal-oral route and is a major cause of acute viral hepatitis. The clinical manifestations of HAV infection range from asymptomatic infection to acute liver failure (ALF), but do not include progression to chronic hepatitis. Risk factors for severe acute hepatitis A are older age (>40 years) and preexisting liver disease. Some patients may show atypical clinical features such as relapsing hepatitis, prolonged cholestasis, or extrahepatic manifestations. Almost all hepatitis A patients spontaneously recover with supportive care. However, in the case of ALF (<1%), intensive care and urgent decision on liver transplantation are required. Liver injury during hepatitis A is not directly caused by HAV but is known to be caused by immune-mediated mechanisms. In this review, the natural history and clinical manifestations of hepatitis A are described. In addition, mechanisms of immunopathogenesis in hepatitis A are discussed.
甲型肝炎病毒（HAV）通过粪-口途径传播，是急性病毒性肝炎的主要病因。HAV 感染的临床表现从无症状感染到急性肝衰竭（ALF）不等，但不包括进展为慢性肝炎。重型急性甲型肝炎的危险因素包括年龄较大（>40 岁）和存在肝脏疾病。一些患者可能表现出非典型的临床特征，如肝炎复发、持续胆汁淤积或肝外表现。几乎所有甲型肝炎患者均可通过支持性治疗自发恢复。然而，在急性肝衰竭（<1%）的情况下，需要重症监护和紧急决定进行肝移植。甲型肝炎中的肝损伤不是由 HAV 直接引起的，而是已知由免疫介导的机制引起的。在这篇综述中，描述了甲型肝炎的自然史和临床表现。此外，还讨论了甲型肝炎的免疫发病机制。
