Swartling Lisa, Nordén Rickard, Samuelsson Ebba, Boriskina Ksenia, Valentini Davide, Westin Johan, Norder Heléne, Sparrelid Elda, Ljungman Per
Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Bone Marrow Transplant. 2020 Jul;55(7):1255-1263. doi: 10.1038/s41409-020-0823-7. Epub 2020 Feb 18.
Hepatitis E virus (HEV) can cause chronic infection and liver cirrhosis in immunocompromised individuals. The frequency and clinical importance of HEV was studied retrospectively in a cohort of 236 Swedish allogeneic hematopoietic stem cell transplantation (HSCT) recipients. In blood samples collected at 6 months after HSCT, HEV RNA was identified in 8/236 (3.4%) patients, and 11/236 (4.7%) patients had detectable anti-HEV IgG and/or IgM, eight of whom were HEV RNA negative. Two of the patients with positive HEV RNA died with ongoing signs of hepatitis: one of acute liver and multiple organ failure, the other of unrelated causes. The remaining six patients with HEV RNA had cleared the infection at 7-24 (median 8.5) months after HSCT. HEV infection was associated with elevated alanine aminotransferase at 6 months after HSCT (OR 15, 1.3-174, p = 0.03). Active graft-versus-host disease of the liver at 6 months after HSCT was present in 3/8 (38%) patients with HEV RNA, but was not significantly associated with HEV infection. In conclusion, HEV infection is an important differential diagnosis in patients with elevated liver enzymes after HSCT. Although spontaneous clearance was common, the clinical course may be severe.
戊型肝炎病毒（HEV）可在免疫功能低下的个体中引起慢性感染和肝硬化。我们对236名瑞典异基因造血干细胞移植（HSCT）受者进行了回顾性研究，以了解HEV感染的频率及其临床重要性。在HSCT后6个月采集的血样中，8/236（3.4%）例患者检测到HEV RNA，11/236（4.7%）例患者抗HEV IgG和/或IgM检测呈阳性，其中8例HEV RNA检测为阴性。2例HEV RNA阳性患者死于持续的肝炎症状：1例死于急性肝衰竭和多器官功能衰竭，另1例死于其他无关原因。其余6例HEV RNA阳性患者在HSCT后7 - 24个月（中位数8.5个月）清除了感染。HEV感染与HSCT后6个月丙氨酸转氨酶升高相关（比值比15，1.3 - 174，p = 0.03）。HSCT后6个月，8例HEV RNA阳性患者中有3例（38%）出现肝脏移植物抗宿主病，但与HEV感染无显著相关性。总之，HEV感染是HSCT后肝酶升高患者的重要鉴别诊断。虽然自发清除较为常见，但临床过程可能较为严重。
