Llovet Laura-Patricia, Gratacós-Ginés Jordi, Ortiz Oswaldo, Rodriguez-Tajes Sergio, Lens Sabela, Reverter Enric, Ruiz-Ortiz Estibaliz, Costa Josep, Viñas Odette, Forns Xavier, Parés Albert, Londoño María-Carlota
Liver Unit, Hospital Clinic Barcelona, CIBERehd, IDIBAPS, Barcelona, Spain.
Immunology Department, Centre Diagnòstic Biomèdic, Hospital Clínic Barcelona, IDIBAPS, Barcelona, Spain.
Liver Int. 2020 Mar;40(3):558-564. doi: 10.1111/liv.14332. Epub 2020 Jan 9.
Recent studies have found an increase in the seroprevalence of hepatitis E virus (HEV) infection in patients with autoimmune hepatitis (AIH). We aimed to assess the prevalence of positive anti-HEV IgM and IgG, and HEV-RNA in a cohort of patients with AIH, to determine the impact of positive HEV serology on patient outcome, and to evaluate the role of hypergammaglobulinemia and positive autoantibodies in the presence of positive anti-HEV serology.
One hundred and five patients tested for HEV infection between 2014 and 2018 were included in the study: 50 with chronic AIH (more than 1 year on treatment), and 55 with an acute hepatitis (30 patients with acute AIH and 25 with non-AIH).
Seroprevalence of HEV was higher in patients with acute AIH (17% vs 10% in patients with chronic AIH and 8% in patients with non-AIH). Patients with acute AIH and positive anti-HEV IgG were older (58 vs 40; P = .006), had higher IgG levels (27 g/dL vs 13 g/dL; P = .03) and antismooth muscle antibodies (ASMA) titres (1:160 vs 1:80; P = .045), and were more likely to have another autoimmune disease (60% vs 16%; P = .03). At the time of HEV testing, anti-HEV IgG positive patients had significantly higher serum IgG levels (17 g/L vs 11 g/L; P = .009), ANA (1:160 vs 1:60; P = .026) and ASMA titres (1:80 vs 1:40; P = .021).
Seroprevalence of HEV in patients with AIH in Catalonia does not differ from that of the general population. The higher HEV seroprevalence in patients with acute AIH with higher levels of gammaglobulins and high antibody titres suggest the presence of cross-reactivity between HEV and liver antigens.
近期研究发现，自身免疫性肝炎（AIH）患者中戊型肝炎病毒（HEV）感染的血清学阳性率有所上升。我们旨在评估一组AIH患者中抗HEV IgM和IgG以及HEV-RNA的阳性率，确定HEV血清学阳性对患者预后的影响，并评估高球蛋白血症和自身抗体阳性在抗HEV血清学阳性情况下的作用。
本研究纳入了2014年至2018年间接受HEV感染检测的105例患者：50例慢性AIH患者（治疗超过1年），以及55例急性肝炎患者（30例急性AIH患者和25例非AIH患者）。
急性AIH患者中HEV的血清学阳性率更高（急性AIH患者为17%，慢性AIH患者为10%，非AIH患者为8%）。急性AIH且抗HEV IgG阳性的患者年龄更大（58岁对40岁；P = 0.006），IgG水平更高（27 g/dL对13 g/dL；P = 0.03），抗平滑肌抗体（ASMA）滴度更高（1:160对1:80；P = 0.045），并且更有可能患有另一种自身免疫性疾病（60%对16%；P = 0.03）。在进行HEV检测时，抗HEV IgG阳性患者的血清IgG水平（17 g/L对11 g/L；P = 0.009）、抗核抗体（ANA）（1:160对1:60；P = 0.026）和ASMA滴度（1:80对1:40；P = 0.021）显著更高。
加泰罗尼亚地区AIH患者中HEV的血清学阳性率与普通人群无异。急性AIH患者中较高的HEV血清学阳性率以及较高的球蛋白水平和高抗体滴度表明HEV与肝脏抗原之间存在交叉反应。
