Royal Liverpool University Hospital, Liverpool, UK; University of Liverpool, Liverpool, UK.
HEViDrAG, Queens Park, London, UK.
Clin Microbiol Infect. 2020 Jul;26(7):828-832. doi: 10.1016/j.cmi.2020.03.039. Epub 2020 Apr 3.
Hepatitis E virus (HEV) is a common cause of viral hepatitis worldwide. Previously considered a disease of the developing world, it is increasingly recognized that locally acquired HEV infection is common in industrialized countries.
The aim was to highlight the changing epidemiology of HEV infection, particularly in the developed world, and inform clinicians of the diverse clinical presentations and extra-hepatic complications associated with the virus.
References for this review were identified through searches of MEDLINE/PubMed, and Google Scholar, up to January 2020. Searches were restricted to articles published in English.
Hepatitis E virus is an under-recognized, emerging pathogen with important implications for public health in both the developing and developed world. The number of cases reported in resource-rich settings is increasing, in part due to improved case ascertainment but also as a result of increased incidence in some countries. The reasons behind these epidemiological shifts are not currently known. Chronic HEV infection has been reported in immunocompromised patients. A range of extra-hepatic manifestations have also been reported, most notably neurological and renal complications. There is evidence to suggest a causal link with Guillain-Barré syndrome, neuralgic amyotrophy and encephalitis/myelitis. Glomerular disease has been reported in the context of both acute and chronic infection.
HEV should be included in non-invasive liver screens and considered in the differentials for patients presenting with alanine aminotransferase elevation, suspected drug-induced liver injury or decompensated liver disease. Any patients with acute neurological injury and deranged liver function should be tested for hepatitis E, and all patients presenting with Guillain-Barré syndrome or neuralgic amyotrophy should be tested regardless of liver enzymes. Immunocompromised patients with persistently raised liver enzymes should be tested with molecular techniques and offered annual routine screening.
戊型肝炎病毒（HEV）是全球范围内病毒性肝炎的常见病因。既往认为该病主要发生在发展中国家，但目前已认识到，在工业化国家，本地获得性 HEV 感染也很常见。
本文旨在强调 HEV 感染的流行病学变化，尤其是在发达国家，并向临床医生介绍与该病毒相关的多种临床表现和肝外并发症。
通过在 MEDLINE/PubMed 和 Google Scholar 上搜索，截至 2020 年 1 月，确定了本文的参考文献。检索限定于发表在英文期刊上的文章。
戊型肝炎病毒是一种被低估的新兴病原体，对发展中国家和发达国家的公共卫生均具有重要意义。在资源丰富的地区报告的病例数量正在增加，部分原因是由于更好地确定了病例，但部分原因也是由于某些国家的发病率增加。造成这些流行病学变化的原因目前尚不清楚。免疫功能低下的患者可发生慢性 HEV 感染。也已报告了一系列肝外表现，最常见的是神经和肾脏并发症。有证据表明，戊型肝炎病毒与格林-巴利综合征、神经痛性肌萎缩和脑炎/脊髓炎之间存在因果关系。在急性和慢性感染中均已报告肾小球疾病。
应将 HEV 纳入非侵入性肝脏筛查，并在出现丙氨酸氨基转移酶升高、疑似药物性肝损伤或肝功能失代偿的患者中考虑进行鉴别诊断。任何出现急性神经损伤和肝功能异常的患者均应进行 HEV 检测，所有出现格林-巴利综合征或神经痛性肌萎缩的患者均应进行检测，而无论其肝功能酶是否异常。持续存在肝酶升高的免疫功能低下患者应采用分子技术进行检测，并提供年度常规筛查。
