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在自身免疫性肝炎的诊断时,儿童的甲型肝炎病毒和细小病毒 B19 的血清阳性率增加,而成年人的戊型肝炎病毒的血清阳性率也增加。

Increased seroprevalence of HAV and parvovirus B19 in children and of HEV in adults at diagnosis of autoimmune hepatitis.

机构信息

Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.

Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.

出版信息

Sci Rep. 2018 Nov 28;8(1):17452. doi: 10.1038/s41598-018-35882-7.

Abstract

Preceding viral infections have mostly been described in autoimmune hepatitis (AIH) in single cases. We aimed to identify viral infections that potentially trigger AIH, as suggested for hepatitis E virus (HEV) infections. Therefore, antibodies against hepatitis A (HAV), B, C and E viruses; hepatotropic herpesviruses; and parvovirus B19 (PVB19) were analyzed retrospectively in 219 AIH patients at diagnosis, 356 patients with other liver diseases and 89 children from our center. Untreated adult AIH (aAIH) patients showed higher anti-HEV seroprevalences at diagnosis than patients with other liver diseases. Untreated aAIH patients had no increased incidence of previous hepatitis A, B or C. Antibodies against hepatotropic herpesviruses in untreated AIH were in the range published for the normal population. Untreated pediatric AIH (pAIH) patients had evidence of more previous HAV and PVB19 infections than local age-matched controls. The genetic AIH risk factor HLA DRB103:01 was more frequent in younger patients, and DRB104:01 was more frequent in middle-aged patients without an obvious link to virus seropositivities. Pediatric and adult AIH seem to be distinct in terms of genetic risk factors and preceding viral infections. While associations cannot prove causal relations, the results suggest that hepatotropic virus infections could be involved in AIH pathogenesis.

摘要

先前的病毒感染在自身免疫性肝炎(AIH)中大多为个案报道。我们旨在确定可能引发 AIH 的病毒感染,就像提示戊型肝炎病毒(HEV)感染一样。因此,我们回顾性分析了 219 名 AIH 患者、356 名其他肝病患者和 89 名来自我们中心的儿童在诊断时的甲型肝炎(HAV)、乙型肝炎、丙型肝炎和戊型肝炎病毒、肝嗜性疱疹病毒和微小病毒 B19(PVB19)抗体。未经治疗的成人 AIH(aAIH)患者在诊断时抗 HEV 的血清阳性率高于其他肝病患者。未经治疗的 aAIH 患者既往无甲型肝炎、乙型肝炎或丙型肝炎感染发生率增加。未经治疗的 AIH 患者的肝嗜性疱疹病毒抗体在正常人群报道的范围内。未经治疗的儿科 AIH(pAIH)患者有更多既往 HAV 和 PVB19 感染的证据,而这些感染在当地年龄匹配的对照组中并不常见。遗传 AIH 风险因素 HLA DRB103:01 在年轻患者中更为常见,而 DRB104:01 在中年患者中更为常见,与病毒血清阳性无明显关联。儿科和成人 AIH 在遗传风险因素和先前的病毒感染方面似乎存在差异。虽然关联不能证明因果关系,但结果表明肝嗜性病毒感染可能参与 AIH 的发病机制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/329b/6261942/74e108b71b51/41598_2018_35882_Fig1_HTML.jpg

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