口服疾病修正治疗的多发性硬化症患者中的戊型肝炎病毒感染。
Hepatitis E virus infections in patients with MS on oral disease-modifying treatment.
机构信息
From the Departments of Medicine, University Hospital Basel, Neurologic Clinic and Policlinic, Clinical Research and Biomedicine, University of Basel, Petersgraben, Switzerland.
出版信息
Neurol Neuroimmunol Neuroinflamm. 2019 Jul 11;6(5). doi: 10.1212/NXI.0000000000000594. Print 2019 Sep.
OBJECTIVE
To test whether patients with MS on disease-modifying treatments (DMTs) are at a higher risk of acute or chronic hepatitis E virus (HEV) infections or extrahepatic manifestations, we monitored approximately 1,100 persons with MS (pwMS) during 3 years for HEV infection.
METHODS
This is an observational case series study. All pwMS were followed in our MS center between January 2016 and December 2018 with at least annual standardized clinical and laboratory assessments. Patients with unexplained liver enzyme elevations were routinely screened for HEV infection.
RESULTS
Four cases of acute HEV under DMT (fingolimod [n = 3]; dimethyl fumarate [n = 1]) were identified. Two presented with fulminant icteric hepatitis and one with a HEV-associated neurologic manifestation (neuralgic amyotrophy). No chronic HEV courses were observed. DMT was continued after clearing of HEV or normalization of liver function tests in all cases.
CONCLUSION
HEV infection is an important differential diagnosis of drug-induced liver injury in pwMS under DMT. Our data do not suggest an increased incidence of acute HEV infections or chronification in pwMS. However, epidemiologic studies in immunomodulatory-treated patients are needed to further investigate HEV disease courses and extrahepatic manifestations.
目的
为了测试接受疾病修正治疗（DMT）的多发性硬化症（MS）患者是否具有更高的急性或慢性戊型肝炎病毒（HEV）感染或肝外表现的风险，我们在 3 年内对约 1100 名 MS 患者（pwMS）进行了 HEV 感染监测。
方法
这是一项观察性病例系列研究。所有 pwMS 于 2016 年 1 月至 2018 年 12 月期间在我们的 MS 中心接受了随访，每年至少进行一次标准化的临床和实验室评估。对于不明原因的肝酶升高患者，常规筛查 HEV 感染。
结果
发现了 4 例在 DMT 下的急性 HEV（芬戈莫德[n = 3]；二甲基富马酸[n = 1]）。其中 2 例表现为暴发性黄疸性肝炎，1 例表现为与 HEV 相关的神经表现（神经痛性肌萎缩）。未观察到慢性 HEV 病程。所有病例在清除 HEV 或肝功能试验正常化后均继续使用 DMT。
结论
HEV 感染是 DMT 下 pwMS 药物性肝损伤的重要鉴别诊断。我们的数据并未表明 pwMS 急性 HEV 感染或慢性化的发生率增加。然而，需要进行免疫调节治疗患者的流行病学研究，以进一步研究 HEV 疾病病程和肝外表现。
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